Staff distress among haemophilia nurses

Healthcare professionals in the 'tainted blood' era in Canada: Their forgotten emotions

INTRODUCTION

During the 1970s and early 1980s, Canada's comprehensive care haemophilic programs were established. Newer therapies led to a rapid increase in quality of life and expected life span for persons with haemophilia (PWH). The outlook was bright. However, beginning in 1982, the appearance of HIV/AIDS transmitted by treatment products led to the 'tainted blood' era with its devastating impact on PWH, recently highlighted in the Canadian Broadcasting Corporation mini-series 'Unspeakable'. What has received less notice is how the healthcare professionals (HCP) managing these patients then were affected.

AIM

To report the emotional effects of that era on HCPs.

METHODS

In developing an oral history of haemophilic care in Canada we have interviewed 76 HCPs, the majority of whom had worked in haemophilic clinics during that era. During each interview, we asked the interviewee to reflect on what this did to haemophilic care and to him/herself. The interview responses were analysed.

RESULTS

HCPs have been markedly affected by the events of the 1980s with feelings that persist more than 30 years later. Most related to the loss of so many of their patients and the inability to alter the rapidly changing course of events at the time.

CONCLUSION

The 'tainted blood' era had persistent strong emotional effects on HCPs. They were helpless to stop or to mitigate the devastating epidemics. Wellness support programs were less well developed then. While the focus is in the Canadian context, we suggest that a parallel can be drawn within haemophilic communities in other countries.

Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada

Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.

Stressors and coping strategies for HIV-test counselors giving rapid HIV-test results: an exploratory qualitative study

Stress has been extensively researched in the HIV services field. Yet, research regarding stress related to HIV-test counseling has solely focused on stressors related to giving results, even though stress on the HIV test counselor can occur at many points within a counseling session. This exploratory, qualitative study examines the stressors faced and coping mechanisms utilized by HIV-test counselors at AIDS service organizations (ASOs) during rapid HIV-test counseling sessions. Forty-two HIV test counselors were interviewed regarding HIV-test counseling sessions in which they provided preliminary-positive/reactive, negative/nonreactive, and invalid results. Regardless of the test result, HIV test counselors faced stressors, including giving HIV test results; dealing with emotions; difficult clients; self-doubt; and systemic stressors. Most stress was managed through social support, preparatory coping strategies, respite, and putting things into perspective. Despite the exploratory nature of the study, the findings suggest that strengthening support bases and improving current training standards will increase the well-being of HIV test counselors.

Development and validation of a culturally appropriate HIV/AIDS Stigma Scale for Puerto Rican health professionals in training

HIV/AIDS stigma continues to be an obstacle for primary and secondary HIV prevention. Its consequences for the lives of people living with the disease have been well documented and continue to be of great concern for health care providers and researchers in the field. These consequences are worsened when such stigma emanates from health professionals, as this can limit access to services. One of the main obstacles for HIV/AIDS stigma research in Puerto Rico is the absence of quantitative measures to assess HIV/AIDS stigma manifestations among health professionals. In light of this gap in the scientific literature, the main objective of this study was to develop and test the psychometric properties of a culturally appropriate HIV/AIDS Stigma Scale for Puerto Rican health care providers and to develop a reduced form of the scale suitable for use in time-limited clinical settings. The developed measure was based on previous qualitative evidence gathered from Puerto Rican health professionals (Varas-Diaz, Serrano-Garcia, & Toro-Alfonso, 2005) and administered to a sample of 421 health professionals in training. The scale addresses 12 HIV/AIDS stigma dimensions. In quantitative analyses 11 of these dimensions demonstrated satisfactory validity and reliability. These dimensions in turn were subcomponents of a higher-order general stigma factor. Implications and limitations of these findings are discussed.

Predictors of retention among HIV/hemophilia health care professionals

Health care professionals working with individuals with chronic medical illness, especially those infected with the Human Immunodeficiency Virus (HIV), may be at risk for burnout and departure due to various job stresses such as the death of patients and social stigma. Factors that prevent burnout and employee attrition are seldom studied. Two hundred thirteen staff (doctors, nurses and mental health workers) at a representative sample of Hemophilia Treatment Centers (HTC) completed instruments to measure Burnout (Maslach Burnout Inventory), and perceived job stresses and satisfaction (job tasks, interactions with colleagues and patient care). The staff were surveyed again after two years and their job status determined after 4 years. After 4 years, 35% of the staff had left the field of Hemophilia/HIV care. Univariate tests found that retention was significantly associated with initial job satisfaction, being married and low levels of stress with colleagues. Burnout, as measured by the Maslach Burnout Inventory, at baseline, was unrelated to job retention over 4 years. An adjusted multiple logistic regression of all significant variables found that colleague support was most related to retention (OR=2.8, CI=1.49,5.1). We conclude that attrition of highly trained staff is a significant issue for patients and HTCs. These data suggest the important role that a well-functioning team can have in buffering the inevitable stresses associated with HIV care. Mental Health professionals have considerable expertise in addressing these issues.