Emotional distress among frontline research staff

Towards painless and productive research relationships: reflections on study design by a researcher with chronic pain for participants with chronic pain

Building flexibility into the research design of a study allows for responsiveness to the embodied and fluctuating nature of participants' chronic illnesses, which may be shaped, for instance, by flare-ups and periods of remission of acute pain. Whilst the methodology literature has, to some extent, considered how to accommodate the pain of research participants when designing a study, consideration of how methodological choices are responsive to the researcher's pain needs has not to date been foregrounded. From the perspective of a researcher with Ankylosing Spondylitis (AS), a form of inflammatory arthritis characterized by chronic pain, and Crohn's disease, a type of inflammatory bowel disease, characterized by stomach and joint pain, this paper provides insight into pain and researcher-participant relationships, from the perspective of a researcher in pain, designing a study to accommodate her own pain needs, as well as anticipating the needs of prospective participants in pain. This paper proposes the use of flexible, remote, and asynchronous research methods as ways to make studies inclusive for researchers living with pain, whilst fostering the most fruitful research relationships with participants who also live with pain, thereby moving towards a position of shared vulnerability. It also highlights the relative absence of the researcher's needs and possible vulnerability in ethics forms and considered by research ethics committees, in comparison to the needs and vulnerability of participants.

Addressing Potential Researcher Distress in Nurse-Led Research: Ethical Considerations and Practical Strategies

AIMS

To discuss the need for nurse researchers to consider to the potential for psychological distress when conducting studies on sensitive topics.

DESIGN

Discursive paper.

METHODS

Drawing from existing literature, we highlight the ethical obligations of researchers to recognise and manage their emotional responses, especially as these can potentially lead to burnout and re-traumatization. In this paper, we propose practical strategies to mitigate these risks, including trauma-informed practices, peer support systems, structured mentorship and the establishment of vicarious trauma (VT) plans.

CONCLUSION

Prioritising researcher well-being in nursing research is essential for ethical practices and the mental health of those involved in undertaking research in sensitive areas.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Support strategies, such as formal team debriefings, resilience training, VT plans and peer support, can foster safer and healthier research environments, when researching in sensitive areas.

"Hope is being stirred up": Critical consciousness in gender-based violence interventions

Gender-based violence (GBV) research in public health has historically paid close attention to gender as a system of oppression, with less attention paid to the intersections between gender and other oppressive systems such as colonialism, white supremacy, and capitalism. In 2019, we adapted and pilot-tested an individual-level evidence-based sexual violence resistance intervention for university-attending women in Eswatini. We conducted a qualitative assessment of our adapted intervention's acceptability and feasibility using a critical pedagogy lens to explore how power operated in delivering an empowerment intervention, using in-depth interviews with intervention participants and facilitators. We analyzed interview transcripts thematically guided by a critical pedagogy framework and organized emergent themes into a concept map with two primary axes: participant-researcher-driven power and proximal-distal determinants. We located participant experiences with the intervention within three quadrants defined by these axes: 1) "Prescriptive," in which the researcher or facilitator primarily controls the content and delivery, with a principal focus on proximal risk reduction strategies; 2) "Solidarity," which emphasizes fostering critical consciousness among facilitators and intervention participants through dialogue, building collective power through participant-driven discussions of individual experiences; and 3) "Liberation," in which participants critically examined the power structures that underpinned their lived experiences, and expressed a desire to transform these in ways the intervention was not designed to address. These three quadrants suggest the existence of a fourth quadrant, "paternalistic," - in which the interventionist seeks to didactically educate participants about structural drivers of their own experience. Our analysis highlights a fundamental tension in the epistemology of GBV research: While there is a clear consensus that 'empowerment' is a necessary component of successful GBV interventions, "liberatory" approaches that cede power to participants are inherently antithetical to the scripted approach typically required for consistent replication in randomized control trials or other 'gold-standard' approaches for post-positivist evidence generation.

Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States

Structural barriers perpetuate mental health disparities for minoritized US populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental health care access and relevance. Mutual capacity building partnerships between low and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and shared GMH strategies through a case series of said partnerships between Kenya-North Carolina, South Africa-Maryland, and Mozambique-New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included: qualitative formative work and partnership-building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task-sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science-and facilitating learning across settings-can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.

Considering Risks to Researchers and Staff in Low-Resource Settings during Public Health Crises: A Proposed Conceptual Model

Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.

'Don't cross the line, you're a researcher and not an educator': Incorporating indigenous researchers' moral perspectives to improve ethical protocols in health research

Given that researchers from North America and Europe author most global scientific publications, indigenous frontline researcher perspectives are rarely incorporated in the general research enterprise and ethics. Addressing this shortcoming, we analyzed a subset of data from a larger study. We present results from semi-structured in-depth ethnographic interviews with nine indigenous research assistants (RAs) conducted in Southern Africa four years after implementing a national HIV/AIDS study collaboratively implemented by national, U.S., and European-based stakeholders. The aim is to elucidate how these frontline researchers understand and interpret the task of maintaining their role as researchers and when they felt it more appropriate to cross to prevention educator or interventionist. The obtained results demonstrate how practices intended to protect participants and produce minimally biased ethical data create a conflict for frontline researchers by pitting operational ethics against their humanity. RAs understood and accepted the standard study procedures and the need to maintain their role as researchers. Nevertheless, a majority chose to provide unsolicited information or advice to participants despite the risk of potentially losing their job or causing harm to participants. RAs justified their decision to intervene by the lack and questionable quality of local resources/referrals and the long turnaround from data collection to prevention programming. This article demonstrates how practical exigencies in fulfilling IRB/ethics oversight and designing studies that produce the expected standard of evidence to influence policy and programmatic decisions inadvertently stifle opportunities to translate research into action. We offer specific points of reflection for researchers trained in High Income Country (HIC) perspectives towards decolonizing and improving practices in designing ethical research and establishing reflexive work environments with indigenous researchers.

'Maybe I Shouldn't Talk': The Role of Power in the Telling of Mental Health Recovery Stories

Mental health 'recovery narratives' are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing 'acceptable' stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.

Predictive Factors of the Burnout Syndrome Occurrence in the Healthcare Workers During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is probably the most critical epidemiological situation that human civilization has faced in the last few decades. In this context, of all the professional categories involved in the management of patients with COVID-19 are the most likely to develop burnout syndrome. The main objective of this study is to analyze specific predictive factors of the occurrence and development of the burnout syndrome in the healthcare workers involved in the diagnosis and treatment of patients with COVID-19. The study focused on determining factors of the occurrence, development and maintaining the specific burnout syndrome related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic infection. The study was conducted on a sample of 959 participants, medical personnel from all the public medical entities in Romania(including 5 hospitals): 122 male and 755 female (82 participants did not declare their gender), with a mean age of 42.29 years (SD = 9.97). The sample included 219 doctors, 477 nurses, 214 auxiliary medical personnel and 49 other types of hospital workers. A cross-sectional design was used. Three predictors of the burnout syndrome were identified: Work conditions, Fear of the consequences (including death) determined by the COVID-19 and Need for emotional support. Meaning of work had a moderating role. Several moderated mediation models were tested. The indirect relationship of Work conditions with burnout via Fear of infection was statistically significant; in addition, the indirect effect of Work conditions on burnout through both fear of infection and need for support was statistically significant. The moderation analysis showed that Meaning of work buffer the relationship between Work conditions and Fear of infection. The variance explained by the model including the moderator (30%) was higher than the variance explained by Model 1 (27%), showing that adding the moderating effect of Meaning of work to the relationship of Work conditions with burnout was relevant. The results could be used to design specific interventions to reduce the occurrence of the burnout syndrome in healthcare workers, the implementation of a strategy to motivate employees by highlighting and recognizing the high significance of the work of those in the frontline of the fight against COVID-19.