Too tired to care? The psychological effects of working with trauma

A Socio-Demographic Analysis of Compassion Fatigue among Mental Health Practitioners

MHPs are exposed to the emotional and psychological suffering of their clients on a daily basis, which can take a toll on their own well-being. This study examines the significance of various socio-demographic factors-such as marital status, years of experience, work sector, socio-economic status, and type of MHP-on compassion fatigue, resilience, and coping strategies of MHPs in India. Burnout was found to be higher among single MHPs, while MHPs living with their loved ones demonstrated higher levels of compassion satisfaction and resilience. MPhil & doctoral-level practitioners reported higher levels of secondary traumatic stress, while master's-level practitioners exhibited higher levels of avoidant coping. Job satisfaction was positively correlated with compassion satisfaction and resilience and negatively correlated with burnout and secondary traumatic stress. No significant differences were found based on years of experience or working hours per day. The findings highlight the complex interplay of sociodemographic variables among MHPs.

Compassionate Presence in Seriously Ill Cancer Patients

Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.

Research group as helpers due to the war in Ukraine: Focus group experiences of women researchers

Introduction

World Health Organization studies have shown that one in every five people who have experienced war or other conflicts suffers from a mental health disorder, the most vulnerable groups being children and women. According to international guidelines, mental health care should be made available immediately in the event of disaster. With the first influx of Ukrainian refugees to Hungary at the outbreak of the war, the Research Group of Childhood Mental Health at Eötvös Loránd University and Semmelweis University in Budapest immediately decided to help by transforming itself into a support group for refugee families. The members of the support group are all women. The aim of the present study is to explore the motivation behind the transformation of the research group and the help it provided. A further aim was to compare the group's experiences with descriptions in the literature of impacts on helpers who work with refugees.

Methods

The current paper reflects on the transformation from researchers to helpers and the effects of that transformation at group and individual level using the focus group method and consensual text analysis. The transformation of the support group necessitated the involvement of students, whose experiences are also examined.

Results

We identified five main categories: context; the help recipients' perspective; the personal level; the professional level; and the level between the personal and professional.

Discussion

The analysis revealed the way in which the voluntary helping developed, the resulting difficulties, and coping options. Volunteering among Ukrainian refugees has both positive and negative psychological consequences. While stress and trauma threaten the psychological well-being of the helpers, positive aspects, such as flexibility and professional development, are also reported. Due to the strong motivation among group members and their experience in practical work, the all female research group was quickly able to transform itself into a support group.

Brain functional network changes associated with psychological symptoms in emergency psychological responding professionals after the first wave of COVID-19 pandemic

Background

Emergency psychological responding professionals are recruited to help deal with psychological issues as the Corona Virus Disease 2019 (COVID-19) continues. We aimed to study the neural correlates of psychological states in these emergency psychological responding professionals after exposure to COVID-19 related trauma at baseline and after 1-year self-adjustment.

Methods

Resting-state functional MRI (rs-fMRI) and multiscale network approaches were utilized to evaluate the functional brain activities in emergency psychological professionals after trauma. Temporal (baseline vs. follow-up) and cross-sectional (emergency psychological professionals vs. healthy controls) differences were studied using appropriate t-tests. The brain functional network correlates of psychological symptoms were explored.

Results

At either time-point, significant changes in the ventral attention (VEN) and the default mode network (DMN) were associated with psychological symptoms in emergency psychological professionals. In addition, the emergency psychological professionals whose mental states improved after 1 year demonstrated altered intermodular connectivity strength between several modules in the functional network, mainly linking the DMN, VEN, limbic, and frontoparietal control modules.

Conclusion

Brain functional network alterations and their longitudinal changes varied across groups of EPRT with distinctive clinical features. Exposure to emergent trauma does cause psychological professionals to produce DMN and VEN network changes related to psychological symptoms. About 65% of them will gradually adjust mental states, and the network tends to be rebalanced after a year.

A Mixed Methods Investigation of the Prevalence and Influencing Factors of Compassion Fatigue among Midwives in Different Areas of China

Objective

Exploring the influencing factors of compassion fatigue among midwives to prevent compassion fatigue from occurring and improve their mental health.

Methods

A method integrating the quantitative research method and qualitative research method is used. For the quantitative research, a cross-sectional study was carried out. State-run hospitals from three economic areas in China were selected as investigation scope from June 2018 to May 2021. A total of 515 midwives were chosen randomly from three economic areas. SPSS 22.0 was used for data cleaning and statistical description and analysis. The influencing factors of compassion fatigue among midwives were analyzed by fitting these two-level logistic models. For qualitative research, purposive sampling and maximum variation strategy were used to select midwives with mild or above compassion fatigue in the questionnaire survey. Field study and interviews were used to collect data.

Results

The results in the quantitative research showed that 515 valid questionnaires were received with 82.14% of midwives whose compassion fatigue were moderate or above. Multilevel statistical model analysis demonstrated that hospital level, children situation, area, working atmosphere, experiences of traumatic delivery, sleep quality, and social support level had impacts on the degree of midwives' compassion fatigue (p < 0.05). The result in the qualitative research showed that 34 midwives were interviewed, and 7 topic ideas were refined.

Conclusion

Overall, the incidence of compassion fatigue among midwives is high. Risk factors influencing the degree of midwives' compassion fatigue include lower social support, disharmonious working atmosphere, toddler situation, huge workload, experiences of traumatic delivery, and poor quality of sleep.

Examining the Constructs of Burnout, Compassion Fatigue, Secondary Traumatic Stress in Physicians Using Factor Analyses

Background

Adverse affective experiences have been well-documented in healthcare providers. Research describes them under a variety of terms, including burnout, secondary traumatic stress (STS), and compassion fatigue (CF). The present study evaluates conflicting models of STS, CF, and burnout constructs in physicians.

Methods

Surveys were mailed to all allopathic physicians with active Rhode Island medical licenses. Three hundred and seventy-five complete responses were received. The survey included common measures of STS, CF, and burnout. Confirmatory Factor Analysis (CFA) was used to evaluate discriminant validity of the three constructs and test 5 a priori (1-, 2-, and 3-factor) theoretical models, and Exploratory Factor Analysis (EFA) was planned assess underlying factor structure in the case that CFA did not provide evidence supporting any existing model.

Results

By CFA, all five a priori models of burnout, CF, and STS fail to demonstrate adequate model fit (Standardized Root Mean Square Residual >0.10, Tucker-Lewis Index <0.90). EFA with parallel analysis extracts four factors underlying the three burnout, STS, and CF measures. The four factors describe 54.3% of variance and can be described as (1) depressive mood; (2) primary traumatic stress-like symptoms; (3) responses to patients' trauma; and (4) sleep disturbances.

Conclusion

In spite of abundant discussion surrounding burnout, CF, and STS in physicians, measures of these constructs did not uphold their theoretical factor structures in the present study. Future research might explore other constructs and measures that may describe adverse affective physician experiences.

'Grounding a PIE in the sky': Laying empirical foundations for a psychologically informed environment (PIE) to enhance well-being and practice in a homeless organisation

While psychologically informed environments (PIEs) are gaining in prominence in efforts to improve well-being and practice in the homeless sector, their empirical foundations remain tenuous. We present a unique scoping needs analysis of staff and client well-being, staff attitudes and the social-therapeutic climate in a UK-based homeless prevention organisation (prior to PIE implementation). Our aims were: (a) to apply a robust framework to pinpoint need and target forthcoming PIE initiatives and (b) to establish a validated needs baseline that informs and measures efficacy of PIE for its future development. Four established personal and practice well-being measures were administered to 134 (predominantly 'frontline') staff and 50 clients. Staff completed the: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), Professional Quality of Life Scale (measuring compassion satisfaction [CS], burnout [BO] and secondary traumatic stress [STS]), Attitudes related to Trauma-informed Care Scale (ARTIC-10; measuring practice attitudes towards trauma-informed values) and the Essen Climate Evaluation Schema (EssenCES; measuring perceptions of client cohesion, safety and practitioner relationships in housing projects). Clients completed the WEMWBS and EssenCES. Vulnerability to STS was evident in nearly two-thirds of frontline staff and it was a statistically significant predictor of BO. It was not, however, associated with lesser levels of CS. We discuss this complex dynamic in relation to highlighted strategic recommendations for the PIE framework, and the identified potential challenges in implementing trauma-informed and reflective practice in the organisation. We conclude with a critique of the value and the lessons learnt from our efforts to integrate stronger empirical substance into the PIE approach.

Association between the experience of violence and burnout among paramedics

PURPOSE

Similar to many occupational groups in the rescue service, paramedics show increased mental health problems. Both situational and work-organizational factors play a role in the development of mental illnesses. The aim of the study is to investigate the connection of experienced violence and the development of burnout in the paramedical profession.

METHODS

To analyze this association, 358 paramedics working for a German metropolitan fire brigade were examined using the Hamburg burnout inventory and a questionnaire on the history of violence, using one-factorial variance analyses, t tests and regression analyses.

RESULTS

The examined sample did not show elevated burnout rates, but 97.5% reported that they had already been insulted or spit on while in service. The experience of feeling threatened proved to be a significant predictor for emotional exhaustion and an aggressive response to emotional stress. Also, the experience of being jailed or insulted and the number of years of service are associated with the burnout score. All other experiences showed no significant association with the burnout burden.

CONCLUSION

It can be concluded that specific experiences with violence in the service of paramedics can particularly be associated with burnout symptoms. In general, however, violence seems to play a minor role.

Productive Aging in the Social Work Profession: A Comparison of Licensed Workers 60 Years and Older with Their Younger Counterparts

This article reports the findings of an online survey in 13 U.S. states that compared the self-described demographics, wellness factors (mental health, physical health, and substance misuse), practice factors (fields of practice and work environment issues), and feelings about being a social worker (compassion satisfaction, workplace stress, being glad one chose social work and feeling valued as a professional in society) of 870 employed licensed social workers age 60 and older to 4076 licensed social workers under age 60. The results indicate that the older social workers were more likely to be male and white, less likely to report mental health problems, and more likely to work exclusively in private practice. Although older workers reported more serious physical health problems, they rated their physical health more favorably than their younger counterparts. In both bivariate and multivariate analyses, the older social workers scored significantly higher in compassion satisfaction, being glad they chose social work as a career, and feeling valued as a professional in society. The older social workers scored lower in workplace stress at levels that were statistically significant in a bivariate analysis, but not in a multivariate analysis.

Compassion Fatigue in Pediatric Emergency Department Staff

INTRODUCTION

Compassion fatigue, a product of burnout (BO), secondary traumatic stress (STS), and compassion satisfaction (CS), is reduced capacity and interest in being empathetic for suffering individuals. Our objective was to determine prevalence of compassion fatigue in the pediatric emergency department.

METHODS

We administered the Professional Quality of Life instrument, including BO, STS, and CS scales, to a convenience sample of pediatric emergency department staff (physicians, nurses, technicians, social workers, child life specialists). We categorized participants as having BO (high BO, low CS, moderate-low STS scores), STS (high STS, moderate-low BO, low CS), compassion fatigue (high STS and BO, low CS), and high-risk fatigue (high STS, moderate-low BO, low CS) and low risk (moderate-high CS, moderate-low BO, low STS) of compassion fatigue.

RESULTS

One hundred seventy-seven staff (50% response rate) participated. The majority were white (90%) and female (88%), with participation highest among physicians (97%). Twenty-six percent had low CS scores, 26% had high BO scores, and 20% had high STS scores. Five percent met criteria for categorization as compassion fatigue, 24% for BO, and 24% for low risk of compassion fatigue. Current personal stress was associated with higher BO scores (P = 0.008) and secondary categorization as BO (P = 0.05). Recent work stress was associated with high STS scores (P = 0.03).

DISCUSSION

Five percent of participants met criteria for compassion fatigue; a significant proportion had BO, STS, or CS scores, placing them at risk of compassion fatigue. Future studies should explore factors contributing to and interventions to minimize compassion fatigue.

Effectiveness of Providing Education About Alcohol Use Disorders and Compassion Fatigue for Emergency Department Nurses

BACKGROUND

Emergency departments (EDs) treat over 20,000 patients daily with alcohol use disorders (AUDs). However, nurses receive limited education about AUDs. Studies have shown that ED nurses have negative attitudes about patients with AUDs. Negativity can contribute to the symptoms of compassion fatigue (CF) and to dissatisfaction with work.

PURPOSE

The aim of this study was to design, implement, and evaluate education about AUDs and CF for ED nurses.

DESIGN

This study used a quasi-experimental pretest-posttest within-subjects design.

SAMPLE

A convenience sample of 44 nurses was recruited at a large urban ED.

METHODS

Nurses completed demographics, Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL), and Short Alcohol and Alcohol Problems Perceptions Questionnaire. Then, the nurses participated in 5 hours of an online educational program and a 1-hour live class about AUDs and CF. The surveys were readministered.

RESULTS

The difference in pretest and posttest Short Alcohol and Alcohol Problems Perceptions Questionnaire subscales of role security (expected value = 8.5, p < .006) and therapeutic commitment (expected value = 7.50, p = .018) was statistically significant. For ProQOL constructs, no statistical significance was found. The ProQOL subscales were compared with norms and were statistically significantly different.

CONCLUSION

Nurses' attitudes about patients with AUDs improved after completing the curriculum. Studied nurses had higher levels of professional satisfaction at baseline.

Self-care behaviours and their relationship with Satisfaction and Compassion Fatigue levels among social workers

Compassion fatigue is a syndrome resulting from an empathic listening to the client's distress. Social workers, by the relational nature of their task, can be at risk and may suffer from adverse health effects. This quantitative research (N = 270) aimed to assess the efficiency of social workers' self-care practices. The conclusion is that personal and professional self-care practices reduce compassion fatigue levels as well as increase satisfaction levels. Promoting self-care practices will bring benefits for the professional and, therefore, in the client and the institution.

On the Lived Experience of Sex Offenders' Therapists: Their Perceptions of Intrapersonal and Interpersonal Consequences and Patterns of Coping

In the last two decades, there has been a growing understanding that the therapeutic encounter with sex offenders takes a cost and has consequences on therapists. Despite the increasing research on the consequences of treating sex offenders, these studies in fact, have merely described the consequences, without providing an outlook for how therapists cope with them. The study presented in this article was part of a larger qualitative research project conducted among social workers, using in-depth semi-structured interviews. Emphasis is placed on therapists' perceptions of the intrapersonal and interpersonal consequences they experience from treating sex offenders, as well as the strategies they use to cope with these consequences. The study's central findings concern the therapists' perception of the intrapersonal consequences, which included two levels: primary responses and cumulative responses, and their perception of the interpersonal consequences that included their parenting relationships, intimate relationships, their attitude toward others (strangers and acquaintances), loss of their quality of life, and further positive consequences. The findings indicated a sequence and integrated use of the strategies to cope with the consequences. The results are discussed in light of the theoretical framework of Lazarus and Folkman's stress and coping theory. The limitations of the study as well as its implications for future research are discussed.

Experiences of partners of professional nurses venting traumatic information

Background

Professional nurses employed in trauma units encounter numerous stressors in their practice environment. They use different strategies to cope with this stress, including venting traumatic information to their partners and other family members.

Aims

To describe how partners of professional nurses cope with traumatic information being vented to them.

Methods

A qualitative research method with an interpretive descriptive inquiry design was used to explore, interpret and describe the coping experiences of the nurses’ partners. Purposive sampling was used to select a total of 14 partners, but only ten participated in semi-structured interviews. Tesch’s eight steps of open coding were used for data analysis.

Results

Four main themes were identified indicating adaptive and maladaptive coping skills, namely partners’ experiences of traumatic information vented to them; partners’ coping activities; reciprocal communication and relationship support between partners and nurses; and resilience of partners to deal with the nursing profession.

Conclusion

Partners employed different ways to cope with traumatic information. It was essential for partners and nurses to be supported by nurses’ practice environments and to develop resilience to fulfil reciprocal supportive roles in their relationships.

Secondary Posttraumatic Stress and Nurses' Emotional Responses to Patient's Trauma

Alarmingly high percentages of secondary posttraumatic stress have been reported in several nursing domains such as critical care and emergency nursing, oncology, pediatric nursing, mental health nursing, and midwifery. The purpose of this review is to examine and describe nurses' emotional responses in the face of their exposure to patients' trauma. Lack of understanding of the dynamics of trauma may limit nurses' ability to interact in a meaningful and safe way with patients and their families. Spirituality can be a precious compass in the long-term journey of resolving feelings of grief and loss at work and of building a strong professional identity.

Tragedy in moral case deliberation

In healthcare practice, care providers are confronted with tragic situations, in which they are expected to make choices and decisions that can have far-reaching consequences. This article investigates the role of moral case deliberation (MCD) in dealing with tragic situations. It focuses on experiences of care givers involved in the treatment of a pregnant woman with a brain tumour, and their evaluation of a series of MCD meetings in which the dilemmas around care were discussed. The study was qualitative, focusing on the views and experiences of the participants. A case study design is used by conducting semi-structured interviews (N = 10) with health care professionals who both played a role in the treatment of the patient and attended the MCD. The results show that MCD helps people to deal with tragic situations. An important element of MCD in this respect is making explicit the dilemma and the damage, demonstrating that there is no simple solution. MCD prompts participants to formulate and share personal experiences with one another and thus helps to create a shared perception of the situation as tragic. The article concludes that MCD contributes to the sharing of tragic experiences, and fosters mutual interaction during a tragedy. Its value could be increased through explicit reflection on the aspect of contingency that characterises tragedy.

Compassion satisfaction: A concept analysis in nursing

BACKGROUND

Nurses experience an intrinsic sense of fulfillment derived from their work in caring for other people. There is a need to further investigate the concept of compassion satisfaction as it is experienced in the profession of nursing.

AIM

The aim of this analysis is to provide clarity to the concept of compassion satisfaction in nursing.

DESIGN/DATA SOURCE

A search of social work and nursing literature was completed. The search terms "compassion satisfaction," "nursing," "social workers," "teachers," and "educators" were entered in various combinations to the CINAHL, Journals@Ovid, ProQuest Nursing & Allied Health Source, ProQuest Psychology Journals, PsychINFO, ERIC, and Education Full Text databases.

REVIEW METHODS

A comprehensive review of the literature was completed to identify features of compassion satisfaction. Utilizing the Walker and Avant method, assumptions, antecedents, characteristics, and consequences of compassion satisfaction were identified.

RESULTS

A conceptual model of compassion satisfaction was developed encompassing 7 antecedents, 11 characteristics, and 8 consequences. Further, a theoretical definition of compassion satisfaction in nursing was derived.

CONCLUSION

There is a need to focus on the positive effects of caring. This concept analysis provides the initial step to strengthening the science related to compassion satisfaction in nursing and other helping professions.

Professional Quality of Life and Associated Factors Among Ugandan Midwives Working in Mubende and Mityana Rural Districts

OBJECTIVE

To explore the professional quality of life and associated factors among Ugandan midwives working in Mubende and Mityana rural district to recommend interventions to improve professional well-being and outcomes of midwifery care.

BACKGROUND

Professional quality of life of midwives working in rural areas may be influenced by several personal and work setting factors of care professionals often impacting the quality and outcomes of patient care.

METHODS

A cross-sectional study design was used to collect data from 224 midwives working in two rural districts of Uganda.

FINDINGS

The majority of participants were female (80 %), with an associate degree in midwifery (92 %). The mean age and years of experience were 34 ± 6.3 and 4 ± 2.1 years, respectively. The mean scores on the professional quality of life scale showed average compassionate satisfaction (19 ± 4.88), burnout (36.9 ± 6.22) and secondary traumatic stress (22.9 ± 6.69). The midwives' compassion satisfaction was related to psychological well-being (p < 0.01) and job satisfaction (p < 0.01). Conversely, their burnout levels and secondary traumatic stress were associated with education level (p < 0.01), marital status (p < 0.01), involvement in non-midwifery health care activities (p < 0.01), and physical well-being (p < 0.01). CONCLUSION AND IMPLICATION TO PRACTICE: Midwives working in rural areas of resource-poor countries have moderate professional quality of life and tend to experience moderate to high levels of burnout, secondary traumatic stress and compassion satisfaction in their professional work. Therefore, employers need to provide deliberate work based services such as counselling, debriefing, training and social support to enhance midwives professional quality of life and quality of midwifery care and practice.

Addressing holistic health and work empowerment through a body-mind-spirit intervention program among helping professionals in continuous education: A pilot study

To examine the effectiveness of a body-mind-spirit (BMS) intervention program in improving the holistic well-being and work empowerment among helping professionals in continuous education. Forty-four helping professionals, who were in their first-year part-time postgraduate study, participated in the present study. All participants attended a 3-day BMS intervention program which emphasized a holistic approach to health and well-being. Ratings on their levels of physical distress, daily functioning, affect, spirituality, and psychological empowerment at work were compared before and immediately after the intervention. Participants reported significantly lower levels of negative affect and physical distress, and were less spiritually disoriented after the intervention. Enhanced levels of daily functioning, positive affect, spiritual resilience, and tranquility were also reported. Results also suggested that participants were empowered at work, and specifically felt more able to make an impact on work outcomes. The 3-day BMS intervention program produced a positive and measurable effect on participants' holistic well-being and empowerment at work. Educators in related fields could incorporate holistic practices into the curriculum to better prepare the future practitioners, leading to better outcomes both to the professionals themselves and their clients or patients.

Sustaining Chicago's Informal Caregivers: an Age-Friendly Approach

The concept of age-friendliness has been globally coined by the World Health Organization (WHO) to give value to the physical, social, and environmental factors that can promote or hinder older residents' ability to age in place in cities. The initiative has been very successful in raising awareness among public health policy makers about the generic needs of older adults and urban features that promote active aging. However, the movement has been less focused on highlighting divergent needs of different older adult populations and their informal caregivers. The objective of this mixed method study is to analyze the ratings of 397 caregivers of urban age-friendly features relative to the ratings of 1737 noncaregivers collected as part of a baseline assessment of the age-friendliness of the city of Chicago. Using the approved WHO Vancouver Protocol, the research team also conducted six mixed caregiver/noncaregiver focus groups (n = 84) and three caregiver-only focus groups (n = 21). Survey findings show that informal caregivers rate all eight age-friendly domains with less satisfaction than do noncaregivers. Discussion in focus groups highlighted some of the reasons for these less favorable ratings and foregrounded the domains and themes that mattered most to caregivers. In conclusion, while our study revealed few systematic differences between caregiver and noncaregiver survey satisfaction ratings, caregivers report significantly poorer health than do noncaregivers. In addition, caregiver-only focus groups foregrounded "missing" priority issues specific to caregivers such as respite and the quality of training and flexibility of home help care. Results suggest that one productive next step for researchers would be to widen the usual range of factors considered essential for maintaining the well-being of informal caregivers of community-dwelling older adults. The age-friendly domains provide a starting point for this. Another would be to develop integrated support and improve service responsiveness to particular caregiver/care recipient dyad's physical, psychological, and social needs.

PTSD Symptom Trajectories in Disaster Volunteers: The Role of Self-Efficacy, Social Acknowledgement, and Tasks Carried Out

Millions of volunteers respond after disasters, with a 24% to 46% risk of developing posttraumatic stress disorder (PTSD). It is unclear which symptom trajectories develop and how they differ between core (volunteering before the disaster) and noncore volunteers (joining after the disaster) and which factors predict trajectories. Symptoms of PTSD were assessed at 6-, 12-, and 18-months postearthquake in 449 volunteers in Indonesia. Demographics, previous mental health service use, self-efficacy, social acknowledgment, and type of tasks were assessed at 6 months. In both core and noncore volunteers, 2 PTSD symptom trajectories emerged: a resilient trajectory (moderate levels of symptoms with a slow decrease over time; 90.9%) and a chronic trajectory (higher levels of symptoms with an increase over time; 9.1%). In both trajectories, core volunteers had fewer symptoms than noncore volunteers. Core volunteers in the chronic trajectory were characterized by having sought prior mental help, reported lower levels of self-efficacy and social acknowledgment, and were more likely to have provided psychosocial support to beneficiaries (Cramér's V = .17 to .27, partial η(2) = .02 to .06). Aid organizations should identify and follow up chronic PTSD trajectories in volunteers, including the noncore, who may be out of sight to the organization after the acute response phase.

Engagement as an Element of Safe Inpatient Psychiatric Environments

BACKGROUND

The American Psychiatric Nurses Association (APNA) Institute for Safe Environments (ISE) has focused on key elements that affect safety in psychiatric treatment environments; one of these key elements is patient engagement. An ISE workgroup discussed and reviewed the literature on engagement and safety in inpatient psychiatric settings. This article presents what we have learned about the role that engagement plays in inpatient treatment of severely mentally ill individuals and evidence that links nurse-patient engagement to safety.

OBJECTIVES

To describe, using supporting literature, the role that nurse-patient engagement plays in creating safe, therapeutic environments for individuals with severe mental illness.

DESIGN

(1) Define engagement and describe why it is an important element of safe treatment environments; (2) identify what helps and what hinders patients in their engagement with nurses, and nurses in their engagement with patients; (3) describe how engagement may improve unit safety; and (4) propose recommendations and set future directions for practice, research, and education.

CONCLUSION

Engagement may provide the foundation for safe, therapeutic, and recovery-oriented treatment. In the future, APNA's ISE plans to build upon this foundation by developing a clinical model of nurse-patient engagement and safety by drawing together emerging research and practice models.

Challenges of nurses' deployment to other New York City hospitals in the aftermath of Hurricane Sandy

On October 29, 2012, a 12-ft storm surge generated by Hurricane Sandy necessitated evacuation and temporary closure of three New York City hospitals including NYU Langone Medical Center (NYULMC). NYULMC nurses participated in the evacuation, and 71 % were subsequently deployed to area hospitals to address patient surge for periods from a few days up to 2 months when NYULMC reopened. This mixed methods study explored nurses' experience in the immediate disaster and the subsequent deployment. More than 50 % of deployed nurse participants reported the experience to be extremely or very stressful. Deployed nurses encountered practice challenges related to working in an unfamiliar environment, limited orientation, legal concerns about clinical assignments. They experienced psychosocial challenges associated with the intense experience of the evacuation, uncertainty about future employment, and the increased demands of managing the deployment. Findings provide data to inform national and regional policies to support nurses in future deployments.

The design of compassionate care

AIMS AND OBJECTIVES

To investigate the tension between individual and organisational responses to contemporary demands for compassionate interactions in health care.

BACKGROUND

Health care is often said to need more compassion among its practitioners. However, this represents a rather simplistic view of the issue, situating the problem with individual practitioners rather than focusing on the overall design of care and healthcare organisations, which have often adopted a production-line approach.

DESIGN

This is a position paper informed by a narrative literature review.

METHODS

A search of the PubMed, Science Direct and CINAHL databases for the terms compassion, care and design was conducted in the research literature published from 2000 through to mid-2013.

RESULTS

There is a relatively large literature on compassion in health care, where authors discuss the value of imbuing a variety of aspects of health services with compassion including nurses, other practitioners and, ultimately, among patients. This contrasts with the rather limited attention that compassionate practice has received in healthcare curricula and the lack of attention to how compassion is informed by organisational structures and processes. We discuss how making the clinic more welcoming for patients and promoting bidirectional compassion and compassion formation in nursing education can be part of an overall approach to the design of compassionate care.

CONCLUSIONS

We discuss a number of ways in which compassion can be enhanced through training, educational and organisational design, through exploiting the potential of brief opportunities for communication and through initiatives involving patients and service users, as well as practitioners and service leaders.

RELEVANCE TO CLINICAL PRACTICE

The development of contemporary healthcare systems could usefully address the overall design of compassionate care rather than blame individual practitioners for a lack of compassion.

Witness to suffering: mindfulness and compassion fatigue among traumatic bereavement volunteers and professionals

This study used a survey to investigate the relationship between mindfulness and compassion fatigue and compassion satisfaction among 41 volunteers and professionals at an agency serving the traumatically bereaved. Compassion fatigue comprises two aspects: secondary traumatic stress and burnout. Because prior research suggests that compassion satisfaction may protect against compassion fatigue, the authors hypothesized that (a) mindfulness would be positively correlated with compassion satisfaction, (b) mindfulness would be inversely correlated with compassion fatigue, and (c) there would be differences between respondents with a personal history of traumatic bereavement and those with no such history. Correlation analyses supported the first two hypotheses; an independent means t test did not provide evidence for the latter hypothesis, although the number ofnontraumatically bereaved respondents was small. Overall, this sample showed surprisingly high levels of compassion satisfaction and low levels of compassion fatigue, even among respondents thought to be at higher risk of problems due to personal trauma. Implications of these findings are particularly relevant for social workers and other professionals employed in positions in which they encounter trauma and high emotional stress.

Interdisciplinary team communication among forensic nurses and rape victim advocates

Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.

Compassion fatigue and satisfaction: a cross-sectional survey among US healthcare workers

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self-report instrument in a community hospital in the United States. A cross-sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.

The Experiences of Suffering of Palliative Care Informal Caregivers in Malaysia

A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 15 palliative care informal caregivers in University Malaya Medical Centre. The data were thematically analyzed. Seven basic themes were generated (1) empathic suffering, (2) anticipatory grief, (3) obsessive–compulsive suffering, (4) helpless–powerless suffering, (5) obligatory suffering, (6) impedimental suffering, and (7) repercussion suffering. A model of compassion suffering was conceptualized from the analysis. This model may serve as a guide in the assessment and management of suffering in palliative care informal caregivers.

Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients

BACKGROUND

Therapists who work with trauma clients are impacted both positively and negatively. However, most studies have tended to focus on the negative impact of the work, the quantitative evidence has been inconsistent, and the research has primarily been conducted outside the United Kingdom.

OBJECTIVES

This study aimed to assess the prevalence of, and identify predictor variables for, compassion satisfaction, burnout, and secondary traumatic stress in a group of UK therapists (N=253) working with adult trauma clients.

METHOD

An online questionnaire was developed which used The Professional Quality of Life Scale (Version 5) to assess compassion satisfaction, burnout, and secondary traumatic stress and collect demographics and other pertinent information.

RESULTS

Whilst the majority of therapists scored within the average range for compassion satisfaction and burnout, 70% of scores indicated that therapists were at high risk of secondary traumatic stress. Maturity, time spent engaging in research and development activities, a higher perceived supportiveness of management, and supervision predicted higher potential for compassion satisfaction. Youth and a lower perceived supportiveness of management predicted higher risk of burnout. A higher risk of secondary traumatic stress was predicted in therapists engaging in more individual supervision and self-care activities, as well as those who had a personal trauma history.

CONCLUSIONS

UK therapists working with trauma clients are at high risk of being negatively impacted by their work, obtaining scores which suggest a risk of developing secondary traumatic stress. Of particular note was that exposure to trauma stories did not significantly predict secondary traumatic stress scores as suggested by theory. However, the negative impact of working with trauma clients was balanced by the potential for a positive outcome from trauma work as a majority indicated an average potential for compassion satisfaction.

Explosions and human health: the long-term effects of blast injury

The immediate patterns of injury from explosions are well documented, from both military and civil experience. However, few studies have focused on less immediately apparent health consequences and latent effects of explosions in survivors, emergency responders and the surrounding community. This review aimed to analyze the risks to health following an explosion in a civil setting. A comprehensive review of the open literature was conducted, and data on 10 relevant military, civilian and industrial events were collected. Events were selected according to availability of published studies and involvement of large numbers of people injured. In addition, structured interviews with experts in the field were conducted, and existing national guidelines reviewed. The review revealed significant and potentially long-term health implications affecting various body systems and psychological well-being following exposure to an explosion. An awareness of the short- and long-term health effects of explosions is essential in screening for blast injuries, and identifying latent pathologies that could otherwise be overlooked in stressful situations with other visually distracting injuries and, often, mass casualties. Such knowledge would guide responsible medical staff in implementing early appropriate interventions to reduce the burden of long-term sequelae. Effective planning and response strategies would ensure accessibility of appropriate health care resources and evidence-based information in the aftermath of an explosion.

Cognitive behavioural therapy for occupational trauma: a systematic literature review exploring the effects of occupational trauma and the existing CBT support pathways and interventions for staff working within mental healthcare including allied professions

This study performed a systematic literature review to examine existing and recommended CBT support for staff working within mental healthcare, who experienced occupational traumatization. The following questions were posed: (1) What are the effects of differing levels of occupational trauma on the individual and/or organization? (2) Are there any current CBT-specific models, or treatment pathways, aimed at supporting those experiencing the effects of occupational trauma? Conclusions showed the effects of occupational trauma are significant, varied and predominantly negative to both employees, and the organizations where they work. There were no CBT-specific models or pathways sourced to address occupational trauma; however, interventions were highlighted which may form parts of a larger pathway. Reviewed evidence suggests that development of a stepped CBT pathway for occupational trauma will be beneficial.

Compassion fatigue in family caregivers: a Wilsonian concept analysis

AIM

An analysis of the concept of compassion fatigue in family caregivers.

BACKGROUND

The term 'compassion fatigue' is predominantly used with professional caregivers, such as nurses, doctors and social workers. Secondary traumatic stress, burnout, and other related terms are often cited in the literature in conjunction with compassion fatigue. Although compassion fatigue is linked to professional caregivers as a result of exposure to traumatizing events, minimal knowledge has been developed regarding its presence in family caregivers.

DATA SOURCES

Literature published between 1980-2010 from the humanities, nursing and the social sciences, including psychology, sociology, social work, and religion, was reviewed. Data sources included dictionaries, newspapers and multiple academic databases, such as Academic Search Complete, Atla, CINAHL, PsychInfo, and PubMed.

REVIEW METHODS

Wilson's concept analysis strategy was employed to frame the analysis of compassion fatigue, using model, contrary, related, and borderline cases to illustrate the concept's meaning in relation to family caregivers.

RESULTS

Analysis revealed that the concept is predominantly used in relation to healthcare providers. Parallels are drawn between the role of healthcare providers and family caregivers. Compassion fatigue occurs when a care-giving relationship founded on empathy potentially results in a deep psychological response to stress that progresses to physical, psychological, spiritual, and social exhaustion in the family caregiver.

CONCLUSION

This concept analysis clarified the definition and revealed that the concept of compassion fatigue has potential use with family caregivers. Implications for practice and research are identified.

The effects of fatigue on performance in simulated nursing work

Fatigue is associated with increased rates of medical errors and healthcare worker injuries, yet existing research in this sector has not considered multiple dimensions of fatigue simultaneously. This study evaluated hypothesised causal relationships between mental and physical fatigue and performance. High and low levels of mental and physical fatigue were induced in 16 participants during simulated nursing work tasks in a laboratory setting. Task-induced changes in fatigue dimensions were quantified using both subjective and objective measures, as were changes in performance on physical and mental tasks. Completing the simulated work tasks increased total fatigue, mental fatigue and physical fatigue in all experimental conditions. Higher physical fatigue adversely affected measures of physical and mental performance, whereas higher mental fatigue had a positive effect on one measure of mental performance. Overall, these results suggest causal effects between manipulated levels of mental and physical fatigue and task-induced changes in mental and physical performance. STATEMENT OF RELEVANCE: Nurse fatigue and performance has implications for patient and provider safety. Results from this study demonstrate the importance of a multidimensional view of fatigue in understanding the causal relationships between fatigue and performance. The findings can guide future work aimed at predicting fatigue-related performance decrements and designing interventions.

Positive and negative emotional responses to workrelated trauma of intensive care nurses in private health care facilities

Intensive care nursing is a stressful occupation and nurses are continually subjected to both primary and secondary trauma. Responses may be positive in the form of compassion satisfaction, or negative in the form of compassion fatigue. However, nurses tend to deny the negative impact of secondary trauma which leads to the silencing response and subsequent burnout. This article explores and describes the presence of these emotions and the relationships between them. A quantitative approach with a non-probability sampling method was used. The sample consisted of 30 registered nurses working in private health care intensive care units in East London, Eastern Cape. Data were gathered via the Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales – Revision IV (ProQOL – R-IV) and the Silencing Response Scale and were analysed according to descriptive statistics and correlation coefficients. Findings suggest a high risk for compassion fatigue, a moderate risk for burnout and the silencing response and moderate potential for compassion satisfaction. A marked negative relationship was found between compassion satisfaction and burnout and a substantial positive relationship between compassion fatigue and burnout, as well as compassion fatigue and the silencing response.OpsommingIntensiewesorgverpleging is ‘n stresvolle beroep en verpleegsters word gedurig aan beide primêre en sekondêre trauma blootgestel. Reaksie hierop kan óf positief wees, in die vorm van empatie-tevredenheid, óf negatief, in die vorm van empatie-uitputting. Verpleegsters is egter geneig om die negatiewe impak van sekondêre trauma te ontken,wat gevolglik tot stilswye en uitbranding kan lei. Hierdie artikel ondersoek en beskryf die teenwoordigheid en verwantskap tussen hierdie emosies. ‘n Kwantitatiewe benadering met ‘n nie-waarskynlikheidsteekproefmetode is gebruik. Die steekproef het bestaan uit 30 geregistreerde verpleegsters wat in privaat-intensiewesorgeenhede in Oos-Londen in die Oos-Kaap werk. Data is met behulp van die vierde hersiening van die ’Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales’ en die ’Silencing Response Scale’ingevorder en verwerk met verwysing na beskrywende statistieke en korrelasiekoëffisiente. Die resultate dui op ‘n hoë risiko vir empatie-uitputting, ‘n matige risiko vir uitbranding en die stilswye-reaksie, sowel as ‘n matige potensiaal vir empatie-tevredenheid. ‘n Beduidende negatiewe verwantskap blyk tussen empatie-tevredenheid en uitbranding te bestaan, terwyl ‘n aansienlik positiewe verwantskap tussen empatie-uitputting en uitbranding en empatieuitputting en die stilswye-reaksie bestaan.

Development of an educational module on provider self-care

Intensive care providers who care for traumatized populations often face multiple traumas for extended periods and are vulnerable to developing lasting symptoms of compassion fatigue and secondary traumatization. Symptoms are often not recognizable until compassion fatigue or secondary traumatization negatively affects the providers' ability to care for their patients. More attention needs to be given to the care of the provider to ensure high-quality patient care, decrease turnover in the profession, and increase productivity. This article provides a framework for the development of an educational module for healthcare providers' self-care. This educational module created the opportunity to share with providers (a) how to explore their own professional experience; (b) how to recognize the different symptoms of compassion fatigue, primary traumatization, and secondary traumatization; (c) factors related to grief reactions; and (d) personal and professional strategies to decrease compassion fatigue and secondary traumatization.