Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis

ABSTRACTBackground: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014.

'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure

Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.

A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses

OBJECTIVES

to investigate the reasons for low patient safety incident reporting among Indonesian nurses.

METHODS

this qualitative case study was conducted among 15 clinical nurses selected purposively from a public hospital in Lampung, Indonesia. Interview guidelines were used for data collection through face-to-face in-depth interviews in July 2022. The thematic approach was used to analyze the data.

RESULTS

in this present study, seven themes emerged (1) Understanding incident reporting; (2) The culture; (3) Consequences of reporting; (4) Socialization and training; (5) Facilities; (6) Feedback; and (7) Rewards and punishments.

FINAL CONSIDERATIONS

these findings should be considered challenges for the patient safety committee and hospital management to increase patient safety incident reporting, particularly among nurses in the hospital.

Psychosocial resources underlying disaster survivors' posttraumatic stress symptom trajectories: insight from in-depth interviews with mothers who survived Hurricane Katrina

Background: Weather-related disasters, including hurricanes, are becoming more frequent and severe due to climate change. Vulnerable populations, such as people with low income and racial and ethnic minorities, are particularly prone to increased levels of physical harm and psychiatric adversity from weather-related events.Objectives: We aimed to explore psychosocial resources and coping of survivors with three different posttraumatic stress symptom (PTSS) trajectories (High-Decreasing, Moderate-Decreasing, and High-Stable), after Hurricane Katrina across two different time points: F1 (1-year post-disaster) and F3 (12 years post-disaster).Method: Participants in this multi-method study were part of a larger cohort of the Resilience in Survivors of Katrina (RISK) project. Transcripts of interviews completed at the two time points were analysed using two qualitative methods, combining thematic analysis and narrative analysis, and providing both breadth of perspectives with the depth of specific case studies.Results: Sixteen survivors completed interviews at both F1 and F3. From our in-depth analysis of the data, we derived five inductive themes: 'Hope,' 'Adaptive vs maladaptive avoidance,' 'Emotional delay,' 'Acceptance, Finding Meaning and Being in the Moment,' and 'Coping strategies.' Survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories experienced hope for future, accepted the hurricane and its results, and found efficient ways to cope with their situation. Survivors with High-Stable PTSS trajectories tended to express a lack of hope for future and struggled to be mindful and accept the hurricane and its harm. Unlike survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories, survivors with High-Stable PTSS trajectories also reported less social and family support and faced more discrimination and racism.Conclusion: There are factors beyond individual-level psychosocial resources that may shape post-disaster resilience. When supporting survivors after a weather-related disaster, it is essential to provide ongoing psychological, financial, and physical assistance to bolster these resources.

Making Sense of Chagas Disease among Mexican Immigrants in California

Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.

Global Collaborative Team Performance for the Revision of the International Classification of Diseases: A Case Study of the World Health Organization Field Studies Coordination Group

Background/Objective: Collaborative teamwork in global mental health presents unique challenges, including the formation and management of international teams composed of multicultural and multilingual professionals with different backgrounds in terms of their training, scientific expertise, and life experience. The purpose of the study was to analyze the performance of the World Health Organization (WHO) Field Studies Coordination Group (FSCG) using an input-processes-output (IPO) team science model to better understand the team's challenges, limitations, and successes in developing the eleventh revision of the International Classification of Diseases (ICD). Method: We thematically analyzed a collection of written texts, including FSCG documents and open-ended qualitative questionnaires, according to the conceptualization of the input-processes-output model of team performance. Results: The FSCG leadership and its members experienced and overcame numerous barriers to become an effective international team and to successfully achieve the goals set forth by WHO. Conclusions: Research is necessary regarding global mental health collaboration to understand and facilitate international collaborations with the goal of contributing to a deeper understanding of mental health and to reduce the global burden of mental disorders around the world.

[Opinions of general practitioners, psychiatrists and psychologists on the clinical practice guidelines for depression]

AIM

To explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists.

DESIGN

Descriptive-exploratory qualitative study based on semi-structured individual and group interviews.

SETTING

Public primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà.

PARTICIPANTS AND CONTEXT

A total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008.

METHOD

Convenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control.

RESULTS

The main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience.

CONCLUSIONS

There are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful.

[Difficult patients in primary care: a quantitative and qualitative study]

AIM

To identify difficult (heartsink) patients (DP), describe their profile, and report the opinions and experiences they evoke in physicians who see them.

DESIGN

Descriptive, cross-sectional study based on quantitative and qualitative methods.

SETTING

Urban health care center.

PARTICIPANTS

Difficult patients were selected daily from among all patients seen in six primary care practices during the period from March to May 2001. Patients were identified according to the diagnostic criteria of Ellis (patients who cause a knot in the stomach when their name appears on the list of patients with an appointment that day) and O'Dowd (patients who cause distress or discomfort).

METHOD

Information was obtained on the number of DP seen, number of visits made by DP, age, sex, type of DP, level of education, occupation, family structure and comorbidity. Type of DP was determined with a modification of the Groves classification (dependent clinger, entitled demander, manipulative help-rejecter, self-destructive denier, somatizer, emotive seducer). We analyzed the opinions DP generated by examining the discourse produced during a discussion group session with 9 physicians from the participating health center and a moderator.

RESULTS

A total of 82 DP were identified (prevalence.7%, i.e., 2.3% of all visits). Most (67.1%) were women. Mean age was 57.8 years (standard deviation 15.2 years). Dependent clinger patients predominated (41%). Most patients had primary-level education (62%), about one-third were retired (35%), and about one-third were married and had children (35%). Most had two or more medical diagnoses (74.4%), and many had at least one psychiatric diagnosis (40.2%).The feelings these patients evoked most often in physicians were irritability and frustration. Most physicians agreed that these patients are rare but have a severe emotional impact. Physicians believe that the skills and strategies they have to help them manage these patients are limited, and consider specific training necessary to improve them.

CONCLUSIONS

Although DP are not a relevant problem in quantitative terms, they cause considerable emotional distress. Specific training in clinical interviewing is felt to be necessary given the difficulties in managing these patients.

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource]

OBJECTIVE

To find what the pharmacy office represents socially to the population that uses it most.

DESIGN

Qualitative study. Analysis of the contents of two discussion groups.

PARTICIPANTS

Women from 30 to 60 years old, urban residents of the Community of Madrid.

MEASUREMENTS AND MAIN RESULTS

The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy".

CONCLUSIONS

Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.