Chronobiological factors for compassion satisfaction and fatigue among ambulatory oncology caregivers

Primary caregivers for victims of chronic illness and or trauma experience both positive and negative emotional consequences. These are broadly classified as compassion satisfaction (CS) and compassion fatigue (CF). Because one of the components of CF, burnout, varies with chronotype and sleep quality, we assessed the influence of chronobiological features on the broader constructs of CS and CF. Responses from primary ambulatory care oncology staff working dayshifts were assessed for potential relationships of chronotype and sleep quality with CS and CF using the professional quality of life scale. These were analyzed further in a multivariate model that included personality and job satisfaction as cofactors. We found that sleep quality was a key contributor to CS development and CF reduction. Morningness was positively linked to CS, but the univariate association was masked in the multivariate model. Job satisfaction (contingent rewards, nature of work and operating procedures) heavily influenced CS and CF development. Agreeableness and openness showed positive correlations with CS and negative with burnout, while emotional stability was linked to reduced CF. While job satisfaction and personality predictably played roles in the development of CS and CF, sleep quality and chronotype contributed significantly to benefits and negative consequences of providing care.     

Empathy in Clinical Practice: How Individual Dispositions,Gender, and Experience Moderate Empathic Concern,Burnout, and Emotional Distress in Physicians

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.     

Animal Suffering: Representations and the Act of Looking

Animal advocacy uses images of nonhuman suffering as a form of normative rhetoric and a method of persuasion. Although much attention has been given to various facets of the depiction of human suffering, images of animal suffering have, to a large extent, escaped closer scrutiny. This paper seeks to remedy the situation by investigating four issues—the risk of aesthetics, the risk of perpetuating moral wrongs, the problem of privacy, and compassion fatigue—as they relate to images of farmed animal suffering. The paper will argue that images of nonhuman suffering are in danger of being interpreted as a form of visual intrigue, and that they invite seldom-asked questions concerning the justification of the act of looking, together with the privacy of nonhuman animals. Moreover, it will be maintained that compassion fatigue commonly affects how these images are perceived. Making use of the views of Susan Sontag, J. M. Coetzee, and Stanley Cohen (among others), it will be argued that, in order to escape the problematic connotations and consequences of the aforementioned issues, a normative dimension pointing toward action must be explicated.     

Life-and-Death Decisions in a Neonatal Intensive Care Unit in Denmark: The Discrete Authority of Origin Stories

In what ways are care and compassion implicated in efforts to establish lives worth living? Drawing on fieldwork in a Danish Neonatal Intensive Care Unit (NICU), in this article we investigate the role of family biographies in conducting life-and-death decisions around premature infants. Guided by a larger literature on citizenship, we view decisions in the NICU as political acts of assigning citizenship. We ask what bodies and biographies can generate and evoke care and compassion among NICU staff and forge entries or exits from the Danish Welfare State. We demonstrate that infants’ origin stories are appointed legitimate forms of suffering in contemporary Danish society and are thus granted an unnoticed form of authority in life-and-death decisions. In this way, we conclude that what comes to constitute a life worth living in the twenty-first-century Danish Welfare State is in fact the worth of the family.     

Kwaliteit van leven bij dementie

Different definitions of quality of life (QOL) are found in the literature. This raised the question which domains are viewed as really important by persons with dementia. In an explorative study the opinions of persons with dementia (community-dwelling and living in nursing homes), were compared to those of professional carers and instruments for QOL in dementia. Data were gathered through interviews, focus groups and literature study. Most QOL-domains mentioned as important by persons with dementia were also acknowledged by carers and in measurement instruments. Some domains, however, were not mentioned by the carers (‘sense of aesthetics’, ‘financial situation’, ‘being useful’ and ‘spirituality’), or not selected in the measuring instruments (‘security and privacy’, ‘self-determination and freedom’, ‘being useful’ and ‘spirituality’). This indicates differences in perspectives on quality of life between persons with dementia, professional caregivers and researchers. Subsequently it was studied to what degree professionals focus on the QoL-domains that persons with dementia consider essential. Caregivers working on 29 units and 3 day care facilities of 13 nursing homes and in 12 meeting centers filled out a questionnaire (N=374). They reported to focus at least to some degree on most domains considered important by persons with dementia. However, little attention was paid to the domains ‘financial situation’ and ‘being useful’. Professionals offering daytime activities focused more than 24-hour care staff on ‘attachment’, ‘enjoyment of activities’, ‘sense of aesthetics’, and ‘being useful’ This article is a translation and merging of 1) Dröes et al. Quality of life in dementia in perspective; an explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia: The International Journal 2006; 5 (4): 533–558, and 2) Gerritsen et al. Differences in perspective: do professional caregivers focus on the Quality of life domains that are important for people with dementia? American Journal of Alzheimer’s Disease and Other Dementias 2007; 22:176–183.     

Death from cancer at home: the carers' perspective.

OBJECTIVES--To collect information from principal carers of people who had died at home with cancer; to identify areas of support which need improvement. DESIGN--Semistructured interviews with carers two to four months after the death. SETTING--38 general practices in the Exeter, Torbay, and Plymouth health districts. SUBJECTS--207 carers. MAIN OUTCOME MEASURES--Services received by carers and quality of support. RESULTS--161 of 207 patients were aged 60 or over. 88 carers were aged under 60, 110 were 60-80, and 9 were > 80. Carers had difficulty in getting urgent professional help in only 15 out of 177 cases. 124 carers were not given advice on financial help and 174 were not told of support available from local charities. Although pain was well controlled, 25% of patients had no relief of other symptoms. Overall, 150 carers considered the support excellent, 45 good, 8 moderate, 2 poor, and 2 had no comment. CONCLUSIONS--Although care has improved in recent years, health professionals need to give carers more advice about help available outside health services. Domestic help was often needed earlier. Better appreciation of carers'' problems is needed.     

Trade-off between human–wildlife conflict risk and recreation conditions

Our study reveals trade-offs associated with human–wildlife conflicts in recreation areas. It is common for recreational users to face risks of wildlife attacks while hiking. Although some studies show that recreational users consider trade-offs between three dimensions of recreational experiences consisting of resource, social and management conditions, there are no studies addressing human–wildlife conflicts from the perspective of the trade-offs for the users. To better understand trade-offs considered by recreational users, we performed a discrete choice experiment. We conducted a questionnaire-based survey among recreational users at the Numameguri hiking trail in Daisetsuzan National Park, Japan, which has a high density of brown bears. Using a series of choice tasks, respondents indicated a preferred trail scenario from a group of alternatives. Scenarios varied in terms of their destinations (resource), crowding (social), management system (management) and bear encounter risk (bear appearances on the trail and bear appearances on mountain slopes seen from the trail). Results show that risk conditions have decisive, negative effects on satisfaction level for those hiking. Specifically, when the risk of encountering brown bears on the trail is high, user satisfaction cannot be increased on the other three dimensions. A consideration of only resource-, social- and management-based indicators is insufficient for understanding recreation experiences in areas with a high risk for human–wildlife conflict. At the recreation areas that are home to large wildlife, a guided tour may leave users more satisfied and safe from wildlife attacks. Understanding trade-offs related to the risk helps tour design and enhances the users’ experience.     

Everyday Life, Culture, and Recovery: Carer Experiences in Care Homes for Individuals with Severe Mental Illness

Supported homes or Care Homes (CHs) have become in-services that play a fundamental role in social-health systems, particularly in mental health systems in Europe and the United States. They provide settings where residents' day-to-day routines are supervised by in-house non-clinician professional carers. Ten semi-structured in-depth interviews were conducted by expert professional carers of persons with schizophrenia to explore interactions and activities between carers and users living in special "Care Homes". Analysis focused primarily on the functions of everyday life and daily routines in the recovery process. Social positioning analysis was used to investigate meanings and subjective experiences of professionals. The analysis revealed the importance of personal interactions in daily routines for recovery. We identified two main concerns guiding professionals' interactions with users: "Bring [users] to the here and now" and "give them the initiative to start actions". We suggest that CHs promote the construction of privileged identity in western urban societies, forming part of the process towards recovery and better social integration.     

The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial

BackgroundStroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers.MethodsThis study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted.DiscussionWe believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management.

Trial registration

ACTRN12615001046594. Registered on 7 October 2015.     

How Could Hospitalisations at the End of Life Have Been Avoided? A Qualitative Retrospective Study of the Perspectives of General Practitioners,Nurses and Family Carers

Background

Although many patients prefer to stay and die at home at the end of life, many are hospitalised. Little is known about how to avoid hospitalisations for patients living at home.

Aim

To describe how hospitalisation at the end of life can be avoided, from the perspective of the GPs, nurses and family carers.

Method

A qualitative design with face-to-face interviews was used. Taking 30 cases of patients who died non-suddenly, 26 GPs, 15 nurses and 18 family carers were interviewed in depth. Of the 30 patients, 20 were hospitalised and 10 were not hospitalised in the last three months of life.

Results

Five key themes that could help avoid hospitalisation at the end of life emerged from the interviews. The key themes were: 1) marking the approach of death, and shifting the mindset; 2) being able to provide acute treatment and care at home; 3) anticipatory discussions and interventions to deal with expected severe problems; 4) guiding and monitoring the patient and family in a holistic way through the illness trajectory; 5) continuity of treatment and care at home. If these five key themes are adopted in an interrelated way, this could help avoid hospitalisations, according to GPs, nurses and family carers.

Conclusions

The five key themes described in this study can be seen as strategies that could help in avoiding hospitalisation at the end of life. It is recommended that for all patients residing at home, GPs and community nurses work together as a team from the moment that it is marked that death is approaching up to the end of life.     

The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review

Background

Working in the stressful environment of the Intensive Care Unit (ICU) is an emotionally charged challenge that might affect the emotional stability of medical staff. The quality of care for ICU patients and their relatives might be threatened through long-term absenteeism or a brain and skill drain if the healthcare professionals leave their jobs prematurely in order to preserve their own health.

Purpose

The purpose of this review is to evaluate the literature related to emotional distress among healthcare professionals in the ICU, with an emphasis on the prevalence of burnout and compassion fatigue and the available preventive strategies.

Methods

A systematic literature review was conducted, using Embase, Medline OvidSP, Cinahl, Web-of-science, PsychINFO, PubMed publisher, Cochrane and Google Scholar for articles published between 1992 and June, 2014. Studies reporting the prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals were included, as well as related intervention studies.

Results

Forty of the 1623 identified publications, which included 14,770 respondents, met the selection criteria. Two studies reported the prevalence of compassion fatigue as 7.3% and 40%; five studies described the prevalence of secondary traumatic stress ranging from 0% to 38.5%. The reported prevalence of burnout in the ICU varied from 0% to 70.1%. A wide range of intervention strategies emerged from the recent literature search, such as different intensivist work schedules, educational programs on coping with emotional distress, improving communication skills, and relaxation methods.

Conclusions

The true prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals remains open for discussion. A thorough exploration of emotional distress in relation to communication skills, ethical rounds, and mindfulness might provide an appropriate starting point for the development of further preventive strategies.     

Integrating Professional Skills in Wildlife Student Education

Abstract: Recent articles have called for enhanced quantitative proficiency in wildlife students, arguing that such training will increase scientific rigor and produce wildlife researchers and managers who are better able to remedy current problems and to address future challenges in wildlife management. The idea that better, or more rigorous, science is the panacea for controversial natural resource problems is a cavalier and common presumption in many applied professions and one to which wildlife science and management is not immune. However, science and management are distinct processes and although scientific rigor is important, dialogue between the 2 processes is more critical for successful interaction. Integrated training that exposes students to nontraditional coursework and develops essential professional skills, such as planning, consensus-building, and communication, can help produce graduates to bridge the science—management gap and promote the conservation of natural resources. Changes in the structure and coursework of university wildlife departments can help to develop more effective wildlife professionals.     

The relationship between sex life satisfaction and job stress of married nurses

ABSTRACT: BACKGROUND: The purpose of this study was to investigate the relationship among work stress, sex life satisfaction, and mental health of married nurses. Demographic information, work stress, sex life satisfaction, sexual desire and mental health measured using the Chinese Health Questionnaire, data were collected from 100 married nurses in Taiwan. FINDINGS: Sex life satisfaction and age were negatively correlated, but sex life satisfaction and sexual desire were positively correlated. The mental health of over-committed nursing staff was not affected. Higher reward for effort was positively correlated with sex life satisfaction. CONCLUSIONS: No matter whether job stress was high or low, receiving a higher reward for effort led to better sex life satisfaction, which had a satisfying positive effect on the nurses' lives. To improve nursing care quality at the hospital, nursing administrators should assist nurses in confronting work stress via positive adjustment, which is associated with the nurses' sexual harmony, and quality of life.     

What Biomonitoring Can and Cannot Tell Us about Causality in Human Health and Ecological Risk Assessments

Biomonitoring can provide exposure and effects information on various stressors (chemical or biological) that can be useful for human health and ecological risk assessments. It has been applied over the years where harmful changes in human health or the environment were observed and which may have warranted more detailed investigation. Sometimes biomonitoring programs may have been useful in determining the significance and/or cause of these harmful observations. These data can help to infer, but not confirm, causality as exemplified in classical studies conducted in humans and wildlife. However, in most cases we note that additional work was needed to provide the information necessary to support or refute causality. Today modern technology provides the ability to measure a wide variety of parameters in environmental media, plants, animals, and humans. Finding a chemical in an environmental medium or biological tissue may be helpful in understanding potential exposure (and perhaps to begin estimating hazard) to humans and ecological receptors, but mere presence does not necessarily help to establish effects or assign causality. In this article we evaluate the strengths and weaknesses, in a risk assessment context, of the use of biomonitoring data to support a determination of causality.     

Factors Related to Preferences for Trap-Neuter–Release Management of Feral Cats Among Illinois Homeowners

ABSTRACT Populations of feral domestic cats have increased throughout the United States, affecting wildlife and warranting attention from a variety of management agencies. This contentious issue requires a greater understanding of public attitudes and preferences for population control. We used data from a 2004 mail survey of Illinois, USA, homeowners’ attitudes towards wildlife and conservation to investigate support for the trap-neuter–release (TNR) of feral cats and to examine factors (demographic, experience, and wildlife values orientations) that may influence preference for TNR as a management option. Age, gender, and wildlife rights values orientations were significant predictors of preference for TNR, while negative experiences with feral cats were correlated with preferences for management options other than TNR. Investigations of public perceptions of feral cat management can help wildlife managers understand the growing public debate regarding feral cat management and provide appropriate input and educational materials regarding cat management and wildlife.     

Exploring the quality of life after denture-wearing within elders in Kaohsiung

doi: 10.1111/j.1741‐2358.2012.00614.x
Exploring the quality of life after denture‐wearing within elders in Kaohsiung Objective: The objective of the research is to investigate whether the elderly people’s quality of life get improved after denture wearing. Material and methods: About 1600 elderly persons, over 65 years old, were sampled as the research target. The overall response rate was 71.62%. The tool of research is a structural questionnaire Oral Health Impact Profile (OHIP) that was used to measure the oral health–related quality of life. Individual’s satisfaction of denture wearing divides into three groups: edentulous individuals who are satisfied with denture wearing, edentulous individuals who are not satisfied with denture wearing and dentulous individuals. Results: The result shows the eight variables, which are oral health condition, frequency of snacks‐eating, age, frequency in participation in social activities, instrumental activities of daily living (IADL), vision, satisfaction with life and physical functions, have significant influence on total OHIP score. Conclusions: Although being edentulous, if the elderly are satisfied with their denture, the quality of life can be maintained and not affected by oral health problems. It is suggested that the further researches can include more relevant factors when in a discussion on the oral health–related quality of life, especially, the subjective perception of individual’s feeling.     

Human–Tiger Conflict in Context: Risks to Lives and Livelihoods in the Bangladesh Sundarbans

People’s perceptions of the risk posed by wild animals to human lives and/or livelihoods can influence the rate at which people intentionally kill these species. Consequently, human–wildlife conflict (HWC) management strategies may benefit from the inclusion of actions which reduce risk perceptions. This study uses Participatory Risk Mapping (PRM) and semi-structured interviews to explore local perceptions and the wider socio-economic context of human–tiger conflict (HTC) in the Bangladesh Sundarbans area. Of the 24 locally-relevant problems identified by the PRM process, tigers were the only problem to be cited by >50 % of respondents. The ‘tiger problem’ was also perceived by villagers to be of relatively high severity. Negative perceptions of tigers in the Sundarbans communities are exacerbated by other locally-experienced poverty-related problems, as well cyclones, floods and soil erosion. Interactions between the problems experienced by villagers, including HTC, result in a complex ‘risk web’ which detrimentally affects lives and livelihoods and ultimately perpetuates poverty levels in the Sundarbans communities. This research demonstrates that PRM and in-depth, qualitative research can enhance understanding of the perceived magnitude and wider socio-economic context of risks from wildlife and aid the identification of risk perception management actions which may help to reduce the number of animals killed by people.     

哈尔滨市十家医院医疗风险管理现状分析姜乃浒毛静馥△齐英△吴国松赵璐郭思佳刘行宇

目的：通过对哈尔滨市10家医院医疗风险管理现状调查,掌握医院医疗风险管理情况,找出存在的问题,提出改进对策,为医院制定科学、完善的医疗风险管理体系提供参考。方法：运用文献法、访谈法、特尔菲法、头脑风暴法等方法;应用SPSS、EXCEL统计软件对数据进行统计学处理。结果：三级医院在风险管理体系相比于二级医院更为完善;两级医院在医护人员独立工作能力,医疗药品和设备的准入,医疗风险信息系统使用,医护人员培训满意度等方面均具有较大差异;大多数医护人员愿意主动报告医疗纠纷;医患沟通效果较好,科室之间沟通协作也比较好。结论：目标医院基本上建立了医疗风险管理体系,但是在功能上、风险管理措施的制定及落实上尚不完善,医疗风险管理人员的专业素质有待提高,医院医疗风险管理意识尚需加强。     

Community Perceptions of the Crop-Feeding Buton Macaque (<Emphasis Type="Italic">Macaca ochreata brunnescens</Emphasis>): an Ethnoprimatological Study on Buton Island,Sulawesi

Human–wildlife overlap is increasing worldwide as a result of agricultural expansion. This can reduce human tolerance of wildlife, especially if wildlife threatens human food sources. The greatest threat to the declining populations of the endemic Buton macaque (Macaca ochreata brunnescens) is habitat destruction, but as a common crop-feeding species, there is also an additional risk of retaliation killings from farmers. Finding means of reducing this risk will thus help secure the long-term future of this range-restricted subspecies. Here, we investigate variability in farmers’ perceptions of primate crop-feeding and mitigation techniques in three farming communities on Buton Island, Indonesia, which differ in wealth and agricultural resources. We employ a mixed methodology, collecting qualitative social data from focus groups and quantitative observational data to measure macaque crop-feeding occurrences. Our findings indicate that the least wealthy community used lethal control methods more frequently than the comparatively wealthier communities, even when the crop-feeding problem was less severe. The least wealthy community also expressed high levels of fear of macaques, and had the most negative perceptions of them. This community also had no knowledge of the macaques’ conservation status or their ecological roles. We recommend that efforts to protect Buton macaques focus on education and the use of effective nonlethal mitigation techniques, such as electric fencing. We also suggest that initiatives to support such measures may be most effectively directed toward communities with relatively low economic wealth and high reliance on subsistence agriculture, especially where crop-feeding wildlife is feared, even when such communities do not experience the highest losses from crop-feeding wildlife.     

Factors related to the fatigue of relief workers in areas affected by the Great East Japan Earthquake: survey results 2.5 years after the disaster

Background

After the Great East Japan Earthquake (March 11, 2011), the fatigue of relief workers became a major problem in affected areas. In the present study, we conducted a questionnaire survey 2.5 years post-disaster identifying factors related to the fatigue of relief workers.

Methods

This survey was cross-sectional and participants (N?=?119) were relief workers living in affected areas. We used a self-administered questionnaire which included participants’ current problems, sources of strong feeling of loss, psychological distress and compassion fatigue. Based on answers (Yes/No) to the fatigue item, we created 2 groups; a Fatigue-group and a Non-fatigue group. We employed bivariate analysis on items with significant differences between the two groups and entered them into a multivariable logistic regression model.

Results

Fifty-seven (48%) reported that they were “very tired” and were assigned to the Fatigue group. The total score of the 6-item Kessler Psychological Distress Scale (K6) and each subscale score (burnout, secondary trauma, and compassion satisfaction) of the Professional Quality of Life measure (Pro-QOL) in the Fatigue group were significantly higher than those in the Non-fatigue group. There were significant differences between the two groups for 11 items relating to current problems and sources of strong feelings of loss, and the following items were extracted as factors related to the fatigue of relief workers: loss of trust in others (adjusted OR, 10.03: 95%CI, 2.30–43.79), no confidence to continue work (adjusted OR, 6.27: 95%CI, 1.72–22.83), loss of important person(s) (adjusted OR, 5.58: 95%CI, 2.05–15.19), and sleep disturbance (adjusted OR, 5.14: 95%CI, 1.93–13.67).

Conclusion

Many relief workers who reported fatigue had experienced various losses and current problems. Adequate consideration and care systems for local relief workers with fatigue should be given for a long-period after a disaster and it is important for the workers themselves to continue accepting support from others and maintaining self-care habits.