Compassion Fatigue, Secondary Traumatic Stress, and Vicarious Traumatization: a Qualitative Review and Research Agenda

"It's my calling", Canadian dog rescuers' motives and experiences for engaging in international dog rescue efforts

The importation of rescue dogs has become an increasingly common occurrence in recent years, often involving industrialized countries as the ultimate destination. However, international dog rescue activities have attracted considerable criticism from the veterinary community and the public due to the associated zoonotic disease and public health risks, as well as the potential poor behaviour of international rescue dogs. The Government of Canada has also recently placed a temporary suspension on all commercial dog imports from non-rabies free countries due to the growing concerns of the zoonotic disease risks. To understand the perspectives and experiences of stakeholders involved in dog import activities in Canada, we interviewed nine members in leadership positions of Canadian-based international dog rescue organizations. Thematic analysis of interview dialogue yielded three themes: 1) Motive, which described the reason behind participants' involvement in international dog rescue; 2) Challenge, which described the major difficulties faced in participants' dog rescue work; 3) Duty, which described participants' beliefs on responsible dog rescue practices. Members of international dog rescue organizations described being driven by strong desires to provide animal and humanitarian aid. However, local dog rescue efforts were constrained by logistical and societal barriers unique to the Canadian context. Additionally, the current study revealed both similarities and differences in occupational experiences between international dog rescue organizations and other animal care professions. Specifically, difficulties with the emotional burden associated with caregiving professions was also present within dog rescue work. However, international dog rescue members also experienced additional challenges due to the stigma surrounding international dog rescue operations. Further research on attitudes held by other stakeholders involved in dog import activities, as well as members of Canadian communities needing dog rescue aid may provide meaningful inputs on how to better support and facilitate local and international dog rescue efforts.

Vicarious trauma among legal practitioners and judicial officers

The term 'vicarious trauma' refers to a range of cumulative and harmful effects from exposure to the trauma of others and is now recognised as a category of causation in the diagnostic criteria of post-traumatic stress disorder. Legal practitioners may be exposed to the risk of harm from vicarious trauma in a number of occupational contexts. This article reviews recent case authority, including a 2023 prosecution of Court Services Victoria for failing to provide a safe workplace in the Coroners Court of Victoria and the High Court decision in Kozarov v Victoria (2022) and the Victoria Court of Appeal decision in Bersee v Victoria (2022). It considers measures that should be taken to provide a workplace for both legal practitioners and judicial officers that is as safe and without risks to health as is reasonably practicable.

The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

The Partial Mediator Role of Satisficing Decision-Making Style Between Trait Emotional Intelligence and Compassion Fatigue in Healthcare Professionals

Background: Compassion fatigue (CF) represents a relevant issue for healthcare professionals. Currently, it is still unclear which psychological mechanism might lead to CF and which might protect workers from that. Decision-making styles, as well as emotional intelligence, might partially account for the presence of CF. Specifically, we hypothesized that a satisficing decision-making style would mediate the relationship between emotional intelligence and CF.Methods: A cross-sectional online survey was conducted on physicians and nurses from Italian Medical Departments. Three self-reported questionnaires were administered to collect data in accordance with our aims. A mediation model with Structural Equation Modeling on the relationship between trait emotional intelligence (TEI) and CF through the maximizing decision-making style was performed.Results: We found a significant relationship between TEI and CF (β = -0.28, SE = 0.04, p < .001). The maximizing style partially mediated this relationship (β = -0.04, SE = 0.01, p < .001). Moreover, negative relationships were found between sex (male), working hours, sleep quality, and CF. Conversely, a positive relationship between age and CF was demonstrated.Conclusions: Being emotionally intelligent resulted as a protective factor for developing CF, while the decision-making styles shaped the risk of developing CF.

Trauma-Informed Care Education Initiative Explores Impact on Perinatal Nurse Secondary Traumatic Stress and Workforce Challenges

BACKGROUND

Psychological trauma refers to long-lasting adverse effects on well-being precipitated by the experience of a distressing event or a combination of events. High rates of psychological birth trauma in patients contribute to secondary traumatic stress (STS) in perinatal nurses, creating workplace challenges and resulting in dissatisfaction, apathy, and attrition. Perinatal nurses experience high rates of STS, and researchers have called for a universal standard of trauma-informed care (TIC). However, there is a lack of published results on effectively creating TIC education in this nurse population.

METHODS

A pre/posttest design evaluated an online pilot evidence-based practice project addressing a perinatal nurse education initiative on STS and its correlation with nurse attitudes toward TIC. Participants include perinatal nurses in the United States (n = 29). Two scales measured the program's effect on nurses: the Secondary Traumatic Stress Scale (STSS) and the Attitudes Related to Trauma-Informed Care (ARTIC) scale.

RESULTS

A paired t test evaluating pre- and postprogram levels of the STSS showed a decrease in STS (t28 = -3.28, P = .003, Cohen's d = 0.609), the ARTIC scale results showed an increased receptiveness to TIC (t28 = 3.8, P < .001, Cohen's d = 0.706], and a not significant correlation was found between pretest STS and ARTIC scores (Spearman' ρ = -0.248, P = .194).

CONCLUSION

This program supported a significant reduction in nurses' identification of STS. Future perinatal nurse education can expand to build a standard of TIC that is patient-centered and reduces nurse STS.

Improving Emotional Safety, Coping, and Resilience Among Women Conducting Research on Sexual and Domestic Violence and Abuse

Secondary trauma arises through indirect exposure to trauma through engaging with first-hand accounts and narratives of traumatic events. While a significant amount of research has explored secondary trauma experienced by professionals who work with survivors of trauma, such as clinicians and front-line service providers, there is little research exploring the experiences of secondary trauma among violence researchers who routinely engage with traumatic first-hand accounts through their work. This study qualitatively explored violence researcher's professional experiences of secondary trauma and their perceptions of what enables and constrains their own coping and resilience. Participants were recruited using purposive sampling methods. Semi-structured interviews were conducted online with seven female violence researchers from the United Kingdom. Questions explored participant's experiences of secondary trauma symptoms related to their research, perceptions of their own coping and resilience, and experiences of organizational support that have enabled or constrained their resilience. Data were analyzed thematically using a coding framework applied reflexively across interview transcripts. All participants reported experiencing symptoms of secondary trauma from their work including cognitive disturbances; altered beliefs of themselves, others or the world; and challenges connecting with others. Participants' assessment of their own expertise in violence research did not generally impact their perception of their own resilience. Organizational support for violence researchers was rarely provided and participants felt generally unsupported-left to manage any resultant distress alone. Research organizations and universities should implement trauma-informed policies which positively transform workplace culture, provide peer support spaces, and conduct effective training in order to mitigate psychological harm and promote resilience among violence researchers. Support should be tailored to the requirements of violence researchers, and institutions should develop policies that are specifically attentive to the needs of researchers who also have lived experience of violence and abuse.

Outside the Clinic Door: How Neighborhood Sociodemographic Disadvantage is Associated with Community Therapist Secondary Traumatic Stress and Emotional Exhaustion

Therapists serving families with high rates of trauma exposure in community mental health clinics face the potential risk of experiencing secondary traumatic stress and emotional exhaustion, both of which pose barriers for the implementation and sustainment of evidence-based practices. Previous research documents negative effects of living in socioeconomic disadvantaged neighborhoods on child development but has not examined the effects of working in these neighborhoods on therapist well-being. The current study merges publicly available data, administrative claims data on mental health services, and therapy survey data to 1) identify associations between neighborhood sociodemographic disadvantage and two community therapist well-being constructs, specifically secondary traumatic stress and emotional exhaustion; and 2) examine potential clinic- and therapist-level explanatory factors in the associations between neighborhood sociodemographic disadvantage and therapist well-being. A cumulative risk index approach was applied to calculate neighborhood sociodemographic disadvantage. Greater neighborhood sociodemographic disadvantage was significantly associated with higher levels of therapist secondary traumatic stress (B=.09, p<.05) but not emotional exhaustion. Because therapists in higher risk neighborhoods face higher secondary traumatic stress levels, additional research is needed to better understand how these therapists can be best supported; thus, supporting families receiving treatment and implementation of evidence-based practices.

[Impact of care for victims of gender violence on the health professionals]

Professionals who work with women victims of gender violence face difficult emotional situations, and it is important to be aware of the emotions and feelings that the attitudes and behaviour of victims and aggressors generate in them. These emotions can become barriers to communication and seriously affect the professional's relationship with victims. Furthermore, they can generate situations of sustained stress, lead to emotional exhaustion, and affect their health, life, and work performance. We describe the consequences, risk factors and warning signs, as well as protective or resilience factors, that are important to know, and we list the current challenges and some recommendations for professionals and management in order to help prevent such effects and improve professional performance without health risks.

Navigating the Shadows of Others' Traumas: An In-Depth Examination of Secondary Traumatic Stress and Psychological Distress among Rescue Professionals

Rescue workers, who often find themselves on the frontlines of traumatic events, face an increased risk of experiencing secondary traumatic stress (STS) and psychological distress (PD). The nature of their work, alongside professional factors, can influence the way these psychological aspects manifest and their level of severity. This study aimed to explore the relationship between STS and PD in rescue workers. Additionally, it sought to understand how factors such as age, years of experience, duration of work, training received and direct exposure to trauma explain significant variations in reporting to STS. To conduct this research, a cross-sectional study design was implemented involving a sample of 80 rescue workers from the Punjab province in Pakistan. Data was collected over eight weeks using the secondary traumatic stress scale (STSS-17) and the general health questionnaire (GHQ-12) as primary assessment tools. Participants' data was analyzed through Pearson correlation analysis, t-tests, and ANOVA. A strong positive correlation between STS and PD among rescue workers was established. Age significantly explains variation in scores, with older workers displaying reduced STS and PD symptoms. Rescue workers working for longer hours reported elevated STS compared to those working shorter shifts. Workers with more extended professional experience showcased lower STS, highlighting the potential resilience acquired over time. The study also underscored the importance of training duration: longer, well-structured training was associated with decreased STS and PD. Interestingly, longer exposure to trauma was found to be related to lower STS scores, albeit this warrants further investigation. This study underscores the intertwined nature of STS and PD among rescue workers and the various modulating factors. The study paves the way for more comprehensive research, expanding geographically and demographically.

Implementation of a Peer-to-Peer Support Program in a Quaternary Pediatric Medical Center

Healthcare worker burnout is a growing epidemic associated with multiple negative outcomes. Compounding the routine stresses of clinical practice, involvement in adverse events can be emotionally devastating. Healthcare organizations have an obligation to mitigate burnout and promote engagement and resiliency. Many institutions have launched wellness initiatives, but the value of these programs is unclear. Here, we describe the implementation of a peer-to-peer support program at our quaternary pediatric medical center. This proactive program is unique in its referral process and scope and has demonstrated efficacy in mitigating the emotional impact of adverse effects. In total, our institution has trained 125 peer supporters. Since initiation, there have been a total of 2187 referrals made to the program. Data collected in 2022 from these referrals showed a 60.3% (n = 1220) response rate to the offer of support. A survey was sent to frontline clinicians from divisions with trained supporters. Of 963 respondents, 71.8% (n = 691) agreed that this program was a valuable resource, and 81.3% (n = 783) recommended peer support to be offered to those involved in adverse and stressful events. Our experience supports that the implementation of a proactive, peer-to-peer support program is both feasible and valuable.

The Interplay among Empathy, Vicarious Trauma, and Burnout in Greek Mental Health Practitioners

BACKGROUND

Mental health professionals are at risk of experiencing vicarious trauma and burnout as a consequence of the nature of their work. Studies and scholars so far have demonstrated that empathy interacts directly with burnout, and they imply an interaction with vicarious trauma. However, research has paid little attention to the interplay among vicarious trauma, empathy, and burnout in mental health professionals who practice psychotherapy. This study examines the interplay between mental health professionals' (those practicing psychotherapy) vicarious trauma and empathy and investigates the ways they contribute to burnout.

METHODS

The sample consisted of 214 mental health professionals (32 males and 182 females), working in the public and private sectors. Specific instruments were administered online to the sample: (a) an improvised demographic questionnaire (age, gender, education, specialty, years of experience, years of supervision); (b) the Counselor Burnout Inventory, validated for the Greek population by Kounenou et al.; (c) the Vicarious Trauma Scale; and (d) the Jefferson Scale of Physician Empathy.

RESULTS

Correlation analysis showed that empathy and vicarious trauma were positively related to burnout. Moreover, multiple regression analysis revealed that supervision, empathy, and, to a greater degree, vicarious trauma have a significant impact on burnout.

CONCLUSION

Unlike relative research on burnout, gender and work experience did not seem to play a significant role in the prediction of burnout in the present study. Several suggestions for future studies, as well as implications for mental health practitioners, are discussed.

Determinants of the Negative Consequences of Secondary Exposure to Trauma in Caregivers of Holocaust Survivors Living in Poland

The aim of the present study, involving 50 caregivers of Holocaust survivors, was to determine the degree of exposure to secondary traumatic stress (STS) and identify the mechanisms of its development. Several standardized measurement tools were used. It was found that a probable diagnosis of STS could be ascertained in 44% of caregivers. The multiple regression analyses model explains 72% of the total variance of STS. The strongest predictor, explaining 37% of the variability, turned out to be disruptions in beliefs about the meaning of life, spirituality and self-worth as a person. In order to reduce STS symptoms in caregivers, attention should be paid primarily to their cognitive functioning, including possible disruptions in basic beliefs.

The Role of Emotion Regulation as a Potential Mediator between Secondary Traumatic Stress, Burnout, and Compassion Satisfaction in Professionals Working in the Forced Migration Field

BACKGROUND

Professionals working with refugees are vicariously exposed to complex traumatic experiences lived by forced migrants, which can lead to the risk of developing secondary traumatic stress, burnout, and a poor compassion satisfaction. The current study aimed to explore the effects of secondary traumatic stress on burnout and compassion satisfaction in 264 Italian professionals working with refugees and forced migrants. Moreover, it examined the mediating role of emotion regulation between secondary traumatic stress and both burnout and compassion satisfaction.

METHODS

A structural equation modeling (SEM) was performed to test the hypothesis.

RESULTS

The results showed that increased levels of secondary traumatic stress were associated with an increase of burnout both directly and indirectly through the mediation of emotion regulation. Emotion regulation also totally mediated the relationship between secondary traumatic stress and compassion satisfaction.

CONCLUSIONS

The results suggested that prevention or interventions programs targeting emotion regulation might be important to improve the professional quality of life of operators working with refugees and forced migrants.

Bereaved in Me: Understanding the Vicarious Grief Experiences Among Helping Professionals During the COVID-19 Pandemic

Literature on the experience of the bereaved during the COVID-19 pandemic suggests how complicated it has been for those who lost loved ones. However, the sense of grief experienced by those who journey with them is relatively unexplored. The present study examines vicarious experiences of grief of healthcare workers, faith-based workers and mental health workers who worked with the bereaved due to COVID-19 deaths. The study was done in two phases. In the first phase, a survey showed that compared to other helping professionals, healthcare workers reported the highest levels of vicarious grief. In the second phase, in-depth interviews revealed five themes: acknowledging contexts of grief, navigating relations with the bereaved, sharing others' grief, internalizing encounters, and negotiating challenges. Findings highlight the need for supportive interventions at the organizational level.

Measuring Trauma- (and Violence-) Informed Care: A Scoping Review

Trauma- (and violence-) informed care (T(V)IC) has emerged as an important practice approach across a spectrum of care settings; however how to measure its implementation and impact has not been well-examined. The purpose of this scoping review is to describe the nature and extent of available measures of T(V)IC, including the cross-cutting concepts of vicarious trauma and implicit bias. Using multiple search strategies, including searches conducted by a professional librarian from database inception to Summer 2020, 1074 articles were retrieved and independently screened for eligibility by two team members. A total of 228 were reviewed in full text, yielding 13 measures that met pre-defined inclusion criteria: 1) full-text available in English; 2) describes the initial development and validation of a measure, that 3) is intended to be used to evaluate T(V)IC. A related review of vicarious trauma measures yielded two that are predominant in this literature. Among the 13 measures identified, there was significant diversity in what aspects of T(V)IC are assessed, with a clear emphasis on "knowledge" and "safety", and less on "collaboration/choice" and "strengths-based" concepts. The items and measures are roughly split in terms of assessing individual-level knowledge, attitudes and practices, and organizational policies and protocols. Few measures examine structural factors, including racism, misogyny, poverty and other inequities, and their impact on people's lives. We conclude that existing measures do not generally cover the full potential range of the T(V)IC, and that those seeking such a measure would need to adapt and/or combine two or more existing tools.

A Scoping Review of Vicarious Trauma Interventions for Service Providers Working With People Who Have Experienced Traumatic Events

Health and human service providers who aid traumatized individuals frequently experience vicarious trauma (VT). Although VT plays a critical role in service providers' mental health and well-being, as well as in the quality of their service provision, little information is available concerning the development and implementation of VT interventions for service providers. To advance the development of evidence in this area, we undertook a scoping review in which we reviewed existing interventions intended to address VT among service providers working with traumatized clients. Searches of electronic databases were conducted to identify studies published in peer-reviewed journals, with no date restrictions. Over 1,315 citations were reviewed, and a total of 27 studies were included in the final review. The findings show that VT interventions in the literature can be divided broadly into four categories: psychoeducation, mindfulness intervention, art and recreational programs, and alternative medicine therapy. The VT interventions reviewed generally showed promise in their key outcomes, including reductions in secondary trauma stress, compassion fatigue, burnout, and other mental health outcomes. However, the current body of research is lacking both in rigor and in specificity regarding the definition of VT. Furthermore, existing VT interventions are generally self-care based and tend to focus on general stress management rather than addressing the specific effects of VT. Therefore, we call for an increase in efforts to tailor VT interventions to different service settings and participant characteristics, as well as greater attention to developing primary VT interventions at the organizational level.

Trends in public interest in child abuse in the United States: An infodemiology study of Google Trends from 2004 to 2022

INTRODUCTION

More than 1 in 7 children in the United States experience abuse annually with rates remaining consistent over the past 2 decades. During this timeframe, several high-profile cases of child abuse and neglect were publicized in national media in addition to multiple investigations uncovering Indigenous children dying from abuse at Indian Boarding Schools. Increased media attention among other public health and medical topics has been linked to increased public interest, thus, our objective was to investigate trends in public interest from 2004 to 2022.

METHODS

To assess trends in public interest, we extracted monthly relative search interest in child abuse from Google Trends. We constructed linear regression to determine the long-term trajectory of interest, and also compared the slope of the trend to other topics, such as domestic violence. Further, we compared mean relative search interest (RSI) from Child Abuse Awareness Month (April) to other months via t-test. Lastly, we assess by-state correlations of RSI and number of children abused.

RESULTS

Since 2004, search interest in child abuse has significantly declined in the United States-more than other related search terms. Child Abuse Awareness Month showed spikes in RSI which were greater than other months. By-state correlations of RSI and abuse were moderate to weak.

CONCLUSION

Despite heavy media attention covering stories of child abuse during the past 2 decades, search interest in child abuse has significantly declined. This trend may be related to aversion to secondary traumatic stress as news broadcasts often include stories of violence-of which child abuse stories may be most provoking. Following journalism guidance from the Centers for Disease Control and Prevention, reporting with focus on resiliency and prevention, rather than the individuals who perpetrated the crime, may provide more community support and increased public interest.

Compassion Fatigue in Informal Caregivers of Children with Cancer; a Section from Turkey

Compassion fatigue is the natural stress caused by the strong desire to help a valued person and alleviate the pain he/she suffers after he/she undergoes a traumatizing event. That caregiver who witnesses the physical suffering of the patient, who makes intense effort during the process deprived of the social, psychological, or economic support they need is among the reasons causing compassion fatigue. In this study, the aim was to test and describe the effects of compassion fatigue on informal caregivers of children with cancer. The study is phenomenological, a form of a qualitative study. The participants were the relatives of children with cancer. The data were obtained through in-depth interviews. The audio-recorded interviews were analyzed through the inductive thematic analysis to obtain answers to the questions. The findings were categorized under four headings which compassion fatigue was addressed: Empathy ability, compassion stress, problems experienced by the participants as components of compassion fatigue. The results of this study demonstrated that mothers were at risk of compassion fatigue. Those who give care to their relatives are faced with problems more than professionals. It is recommended that the implementation of multidisciplinary interventions that will improve caregivers' well-being, and preventive social work interventions, will prevent them from compassion fatigue.

Compassion Fatigue and Coping Mechanisms of Laboratory Animal Professionals from Europe, China, and Japan

Laboratory animal professionals (LAP) may experience situations that contribute to compassion fatigue (CF). The goal of this research was to better understand CF in LAP in and across employment categories. Surveys were distributed through LAP organizational listservs in the European Union (EU), China, and Japan, and results were analyzed to identify CF prevalence, personal and work-related factors, coping mechanisms, and beneficial work-support programs. Independent χ²-tests compared personal and work-related factors and feelings of CF. Feelings of CF and coping mechanisms were compared with personality scores using independent sample t tests. There were 302 respondents from the EU, 39 from China, and 77 from Japan. Over half of respondents from the EU (52%) and China (56%) reported experiencing CF (52%), with fewer (32%) reporting CF in Japan. No major differences were found based on employer type. Personality scores were significantly related to feelings of CF and preferred coping mechanisms. Work-related factors that contributed to feelings of CF in over half of respondents included staffing levels, workplace relationships, and availability of programs geared to address CF. Across regions, talking to someone, physical activity, getting away from work, and self-care were effective coping mechanisms in over 50% of respondents. Fewer than 30% of respondents indicated that their place of employment had CF support programs, and even fewer (8% to 28%) indicated that these programs were helpful. The study results suggest that to be effective, employer CF programs for LAP should consider providing quiet places at work and programs for self-care, promoting physical and mental health and social support systems, and establishing opportunities to memorialize animals.

Vicarious Trauma Scale: Psychometric Properties in a Sample of Social Workers from Spain

As a result of secondary exposure to traumatic material, social workers may experience vicarious trauma. However, the analysis of this variable among social workers is scarce. The Vicarious Trauma Scale (VTS) is a brief instrument designed to measure the stress consequence of shared trauma. This study aims to examine the psychometrics of the VTS in a sample of 448 social workers from Spain. The results from the exploratory and confirmatory factor analyses (EFA and CFA) indicated that the VTS has satisfactory psychometric properties. Different indices of internal consistency supported the reliability of the VTS. Both EFA and CFA revealed the existence of two factors, corresponding to the cognitive and affective consequences of secondary exposure to trauma. Finally, the correlations of the VTS with other relevant and well-known job variables (workload, work-family conflict, detachment, supervisor support, burnout, and engagement) followed the expected pattern, and the VTS differentiated the social workers by their trauma caseload. Therefore, the VTS can be considered an adequate screening method of social workers' vicarious trauma, and its application recommended to examine the possible risk and protective factors and consequences.

Professional Quality of Life in Intensive Care Unit Professionals during COVID-19 Pandemic: A Prospective Observational Cross-sectional Study

Background and aims

The coronavirus disease-2019 (COVID-19) has significant positive and negative impacts on the professional life of intensive care unit (ICU) professionals. This study was conducted to evaluate compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in ICU professionals and to study demographic and occupational variables related to them.

Methods

This prospective observational study was undertaken on ICU professionals involved in direct care of critically ill COVID-19 patients. The online questionnaire consisting of demographic, work-related parameters, and professional quality of life scale version 5 (ProQOL 5) was sent to 1,080 ICU healthcare workers. The subgroups of ProQOL 5, CS, BO, and STS were calculated and compared across study parameters. Linear regression was performed to evaluate variables which were independently associated with ProQOL.

Results

The response rate in the present study was 39.8%, and after evaluation, 320 responses were found eligible for final analysis. There was predominance of average levels of CS, BO, and STS. Female gender, contractual job, lesser work experience, greater workload, and COVID-19 infection in close acquittance of participants were factors observed to independently associated with increase in negative aspects of ProQOL (BO and STS). Further, increase in duty hours and COVID-19 infection in close social circle were observed to independently decrease positive aspects (CS).

Conclusion

This study shows that despite majority of respondents reporting moderate levels BO and STS, CS is maintained during the COVID-19 crisis. The identification of risk factors is vital to support ICU professionals by targeted interventions.

How to cite this article

Kerai S, Doda P, Saxena KN. Professional Quality of Life in Intensive Care Unit Professionals during COVID-19 Pandemic: A Prospective Observational Cross-sectional Study. Indian J Crit Care Med 2022;26(5):604–612.

Empathy and Cognitive Processing as Factors Determining the Consequences of Secondary Exposure to Trauma Among Roman Catholic Clergymen

By helping individuals after traumatic experiences, the helper is also exposed to the consequences of trauma. The aim of this study was to determine the predictors of consequences of secondary exposure to trauma among clergymen and therapists (N = 140) helping victims of trauma in Poland. Symptoms of secondary traumatic stress (STS) were identified in 22.9% of the clergymen and 8.6% of therapists, and secondary posttraumatic growth (SPTG) in 61.4% of the clergymen and 42.9% of therapists. STS and SPTG predictors were identified based on regression models. In the case of clergymen, regret is a determinant of STS, and positive cognitive restructuring of SPTG. Research findings highlight the need to increase awareness of exposure to secondary trauma among the clergy, and for them to acquire greater skills for coping with stress.

Quality of Life among Caregivers of Patients Diagnosed with Major Chronic Disease during COVID-19 in Saudi Arabia

Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers’ QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers’ psychological onuses and physical actions/reactions). The relation between these variables was significant, X² (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels.

The Mediating Role of Cognitive Trauma Processing in the Relationship Between Empathy and Secondary Traumatic Stress Symptoms Among Female Professionals Working With Victims of Violence

One of the negative consequences of indirect trauma exposure is secondary traumatic stress (STS). Professionals helping victims of violence may be at the risk of STS symptoms development. Both empathy and cognitive processing of trauma seem to be important in this process. The aim of the study was to examine the relationship between empathy, cognitive processing of trauma and symptoms of STS in women working with people who have experienced violence trauma. The mediation role of cognitive coping strategies in the relationship between empathy and STS was also checked. A total of 154 female professionals representing three groups (therapists, social workers, and probation officers) were included in the study. The age of the respondents ranged from 26 to 67 years (M = 43.98, SD = 10.83). Three standard measurement tools were included in the study: the modified PTSD Checklist for DSM-5 (PCL-5), the Empathic Sensitivity Scale, and the Cognitive Processing of Trauma Scale. Correlational analysis indicated STS to have positive associations (Pearson's correlation coefficients) with all three aspects of empathy, and three of the five cognitive coping strategies (denial, regret, downward comparison). Mediation analysis performed by the bootstrapping method found strategies of regret and downward comparison to act as mediators in the relationship between STS and empathic concern. The same results were obtained for perspective taking. In addition, the regret and denial strategies mediated the relationship between personal distress and STS. Empathy and cognitive trauma processing may play an important role in STS symptoms development. Preventive programs for professionals helping trauma victims should focus on cognitive processing of trauma and empathy.

Promoting Professional Quality of Life and Resiliency in Sexual Assault Nurse Examiners

BACKGROUND

Sexual assault nurse examiners (SANEs) have received specialized education and clinical training in providing forensic care for sexual assault and abuse victims. SANEs provide compassionate and competent care that promotes emotional recovery for their patients; however, caring for this population puts SANEs at risk for secondary traumatic stress, professional burnout, and compassion fatigue. The research regarding SANEs indicates that there may be multiple personal and organizational factors that affect their development of negative outcomes related to professional quality of life.

PURPOSE

This study explored challenges SANEs experience in their work and what resources are utilized to promote their resiliency and professional quality of life.

METHODS

SANEs were recruited to complete an anonymous online survey through the International Association of Forensic Nurses community; 69 SANEs completed the survey. Eight of the SANEs also participated in follow-up focus groups.

RESULTS

The participants reported many gratifying aspects of their work. They also described challenges related to personal, professional, organizational, and community factors. Many of the reported negative effects align with secondary traumatic stress and professional burnout. The SANEs identified multiple ways to support their resiliency in the context of this difficult work.

IMPLICATIONS

The nature of this work puts SANEs at risk for developing adverse symptoms related to professional quality of life. SANEs need better support and resources to cope with the demands of their work. Findings of this study will be used to design SANE Well, a support application to promote SANE wellness and resiliency.

Perspectives on Mental Health Screening in the Audiology Setting: A Focus Group Study Involving Clinical and Nonclinical Staff

PURPOSE

Audiology clinical guidelines recommend the use of mental health screening tools; however, they remain underutilized in clinical practice. As such, psychological concerns are frequently undetected in adults with hearing loss. This study aimed to better understand audiology clinic staff's perspectives (including audiologists, audiometrists, reception staff, and clinic managers) on how to improve detection of poor mental health by (a) exploring the role of audiology clinic staff in detecting psychological concerns in adults with hearing loss and (b) investigating the appropriateness, acceptability, and usability of several screening tools in an audiology setting.

METHOD

Eleven audiology clinic staff (M _age = 33.9 ± 7.3, range: 25-51 years) participated in a semistructured focus group. First, participants discussed the role of audiology clinic staff in detecting psychological difficulties in adults with hearing loss, including current practices and needs for improving practices. Second, participants discussed the appropriateness, acceptability, and usability of nine standardized mental health screening tools commonly used in wider health care settings.

RESULTS

Audiology clinic staff described their role in being aware of, and detecting, psychological difficulties, as well as their part in promoting an understanding of the link between hearing loss and mental health. Participants described the need to provide support following detection, and highlighted barriers to fulfilling these roles. The use of mental health screening tools was considered to be client and context specific. The language used within the screener was identified as an important factor for its acceptability by audiology clinic staff.

CONCLUSIONS

Audiology clinic staff acknowledged that they have an important role to play in the detection of psychological difficulties and identified the core barriers to using screening tools. Future research may explore the possibility of developing a mental health screening tool specific to the unique experiences of adults with comorbid hearing loss and mental health concerns.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.16702501.

Compassion Fatigue in the Burn Unit: A Review of Quantitative Evidence

Healthcare staff across varied clinical settings are faced with varied stressors that can lead to compassion fatigue. However, there is currently no review examining the phenomenon in-depth in the burn unit. Thus, the current study sought to scope existing studies to ascertain the prevalence, contributing factors, and effects of compassion fatigue in the burn unit. Compassion fatigue was conceptualised as comprising of burnout and secondary traumatic stress. Arksey and O'Malley scoping review approach was used and reported according to the PRISMA extension guidelines. Searches were undertaken across peer-reviewed databases and grey literature sources for quantitative studies. Following the search and screening process, nine studies were retained. Codes were formulated across studies following which narrative synthesis was undertaken. Majority of the studies (n=5) focused on burn care nurses. High levels of emotional exhaustion and depersonalization and comparatively low level of personal achievement were reported among burn care staff which is indicative of burnout. Compassion fatigue was also observed to be high among burn care staff. Contributing factors are varied albeit some variables such as age, staffing levels, remuneration, nature of the work environment, and number of years worked were consistent across some studies. In conclusion, working in the burn unit is challenging with significant stressors that can lead to burnout, traumatic stress, and subsequently, compassion fatigue. Interventions to promote resilience, hardiness, optimal working environment, peer, and psychosocial support are greatly needed.

Validation of the Soul Injury Self-awareness Inventory

Traumatic lifetime experiences can complicate peaceful dying, causing latent wounds such as posttraumatic stress disorder, moral injury, and soul injury to reemerge at the end of life. Soul injury is defined as an overlooked, unassessed wound that separates a person from his/her own sense of self. The Soul Injury Self-awareness Inventory (Soul Injury Inventory) was developed to identify unresolved losses and hurts that threaten a sense of self. The Soul Injury Inventory is a brief, 10-item instrument that opens the door to meaningful conversations with patients, caregivers, and professionals. This article describes 2 validation studies conducted to measure the reliability, internal consistency, and construct validity of the Soul Injury Inventory. In study 1, the Soul Injury Inventory was demonstrated to be a psychometrically sound tool in which all questions contributed significantly to a single factor characterized as soul injury. In receiver operating characteristic analyses, scores less than 23.5 were shown to be indicative of soul injury with optimal sensitivity and specificity. Study 2 demonstrated that the Soul Injury Inventory has excellent test-retest reliability. The Soul Injury Inventory also has strong internal consistency, as demonstrated in studies 1 and 2. These 2 validation studies, taken together, demonstrate that the Soul Injury Inventory is an excellent, invariant measure of soul injury.

Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study

Background

Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period.

Methods

A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients.

Results

Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores.

Conclusions

Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11851-0.

Breaking the taboo: eight Swedish clinical psychologists' experiences of compassion fatigue

Purpose

The aim of the study was to investigate the participating psychologists’ experiences with compassion fatigue, and to identify individual, interpersonal, and organizational factors and strategies perceived as contributing or protecting in relation to compassion fatigue.

Methods

Semi-structured telephone interviews were conducted with eight psychologists (three men and five women) with more than five years of experience in clinical practice. The interviews were analyzed with thematic analysis, generating five themes.

Results

These were organizational and task specific factors which the participants felt contributed to their compassion fatigue (“mission impossible” and “emotional strain”), experiences of compassion fatigue (“consequences”), interpersonal factors that were perceived as contributing or protecting (“interpersonal factors”), and individual factors that were perceived as protecting (“shielding and strengthening factors”).

Conclusions

It was found that all of the participants had experienced negative impact of compassion fatigue on their personal lives. A large quantity of patients, and complex patient cases, as well as high expectations on the psychologists were experienced as contributing factors. Collegial support, an empathetic boss, a high degree of agency at work, and fulfiling activities outside of work were experienced as protecting against compassion fatigue.

Compassion fatigue among obstetricians and gynecologists

Obstetricians and gynecologists are likely to be at risk of occupational distress because their quality of life is affected as a result of their experiences of assisting with traumatic births and/or providing abortions, among others. Nevertheless, there have been few studies of this group of doctors’ compassion fatigue. This study aimed to examine obstetricians and gynecologists’ compassion fatigue. This survey-based quantitative study examined 107 obstetricians and gynecologists’ compassion fatigue. Data were collected using a demographic information form and the Compassion Fatigue Short Scale. This established that had low levels of compassion fatigue related to secondary trauma and job burnout, but moderate levels of it overall. Among female obstetricians and gynecologists, compassion fatigue was higher than among their male counterparts, and respondents who worked at private hospitals had higher compassion fatigue related to secondary trauma than those who worked in state-run hospitals. The data also revealed that obstetricians and gynecologists with 11–15 years’ seniority scored higher on the job-burnout subdimension of compassion fatigue, and overall, than their more senior counterparts. Interestingly, however, no statistically significant differences in the participants’ compassion fatigue were found to be associated with their ages, marital statuses, numbers of children, number of patients seen per day, or number of daily operations performed. Professional sharing groups that allow doctors to share their experiences and to gain awareness about their colleagues’ traumas should be organized. Teamwork should also be encouraged; and various prevention strategies should also be considered.

Effects of end-of-life care on medical health professionals: A dialectical approach

OBJECTIVE

The provision of end-of-life (EOL) care has complex effects on both the professional and personal well-being of medical health personnel (MHP). Previous studies have mostly focused on negative or positive influences as mutually exclusive effects. This study offers a new conceptualization by applying a dialectical lens, looking at secondary traumatic stress (STS) and post-traumatic growth (PTG) as dual possible coexisting phenomena. The creation of four theoretically possible profiles, based on the combinations of high or low levels in each dimension, offers a practical translation of this idea toward intervention development.

METHOD

Data were collected at a large tertiary pediatric medical center (n = 1,123) aiming at assessing all personnel. Research methods included collecting demographic data and using validated scales to assess STS, PTG, burnout, compassion satisfaction, and both personal and professional social support.

RESULTS

We classified four response profiles according to the STS and PTG levels: (1) Dialectical-impact, high STS/high PTG, (2) Growth-dominant, high PTG/low STS, (3) Stress-dominant, high STS/low PTG, and (4) Limited-impact, low STS/low PTG. The four profiles differed based on profession, but not other demographics. Physicians were represented significantly higher in the Stress-dominant profile; nurses were highly represented in the Dialectical-impact profile. A significant difference was found when adding reported EOL care as a distinct factor with a higher relative proportion of the "dialectical" response among those reporting providing EOL care.

SIGNIFICANCE OF RESULTS

Findings from this study point toward the recognition and understanding of the complexity resulting from the provision of EOL care. A more complex profile classification, including the dialectical profile, may reflect a broader tendency to ways that MHP are affected by their work. Introducing "dialectical thinking" can lead to more personalized and precise intervention planning for MHP. Tailored interventions promoting personal and professional well-being, based on individual profiles, can contribute to more effective interventions and better resource utilization.

Incorporating compassion into compassion fatigue: The development of a new scale

OBJECTIVE

Although theory supports compassion fatigue as a separate condition, compassion fatigue, burnout, and secondary traumatic stress (STS) are terms often used interchangeably. We aim to create a compassion fatigue scale while comparing it to burnout and STS.

METHOD

Survey data were collected from 651 psychologists working in Sweden using a Compassion Fatigue Inventory (CFI), the Copenhagen Burnout Inventory, and the STS Scale.

RESULTS

An exploratory factor analysis was used to evaluate the CFI resulting in high internal consistency generating three subfactors: Reduced Compassion, Social Life, and Workplace. Even though Compassion fatigue had a high correlation with both burnout and STS, the results suggest a narrower conceptualization of compassion fatigue. The only background variable related to compassion fatigue was years of work experience.

CONCLUSION

This new CFI can be useful in examining reduced compassion in health care professionals.

A Systematic Review of Job Demands and Resources Associated with Compassion Fatigue in Mental Health Professionals

Psychosocial hazards in mental healthcare contribute to the development of compassion fatigue in mental health professionals. Compassion fatigue has a negative impact on the mental health and wellbeing of professionals that can impair the quality of services provided to clients. The majority of research on compassion fatigue has focused on individual-level variables such as gender, history of trauma and age, among others. It is also imperative to understand the role played by alterable work-related characteristics in contributing to the development of compassion fatigue in order to attenuate its impact on mental health professionals and their clients. The present review examined articles exploring work-related factors associated with compassion fatigue. Fifteen quantitative studies were included and their quality was assessed using a checklist. An inductive content-analysis approach was adopted to synthesise the themes emerging from the data. The results suggested a theoretical model consistent with the Job Demands-Resources model, wherein job demands (such as workplace trauma, workload and therapeutic settings) are associated with compassion fatigue, and job resources (such as supervisors', coworkers' and organisational support) mitigate the impact of job demands. In addition to person-oriented factors, work-related factors are critical for the prevention of compassion fatigue.

The pitfall of empathic concern with chronic fatigue after a disaster in young adults

BACKGROUND

Empathic concern (EC) is an important interpersonal resilience factor that represents positive adaptation, such as "relating to others" (a factor of posttraumatic growth [PTG]) after disaster. However, controversy exists regarding whether the changes in EC (e.g., the intra-personal change between the acute phase and the disillusionment phase) positively or negatively affect mental health after a disaster. We hypothesized that increased EC may increase chronic fatigue due to over-adjustment (hypothesis 1). We also hypothesized that increasing the changes in "relating to others" could decrease the changes in chronic fatigue (hypothesis 2).

METHODS

Forty-nine young, healthy volunteers (M/F: 36/13; age at 3 months after the disaster [3 months]: mean ± SD: 21.1 ± 1.7 years) underwent assessments of EC using the Japanese version of the Interpersonal Reactivity Index, chronic fatigue using the Japanese version of the Checklist Individual Strength (CIS-J) questionnaire, and "relating to others" using the Japanese version of the PTG inventory during the acute phase (3 months) and the disillusionment phase (1 year after the disaster). Pearson product moment correlations at 3 months and 1 year were determined for all scores related to EC. The changes (delta = degree of change from 3 months to 1 year) or scores at 1 year were entered into linear structural equation systems to test the hypotheses.

RESULTS

The delta of EC positively affected the delta of the CIS-J, and the delta of relating to others negatively affected the delta of the CIS-J. Both the EC and relating to others scores were negatively associated with the CIS-J score at 1 year. These results were in accordance with hypothesis 1 and 2.

CONCLUSIONS

We demonstrated the opposite effects of 2 types of ECs, i.e., stability (inherent disposition) and flexibility (degree of change), on the degree of chronic fatigue. Increasing EC with increasing chronic fatigue, but not the change in relating to others, may be a red flag for individuals during the disillusionment phase.