Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting a Professional's Quality of Life

Does Where You Work and What You Do Matter? Testing the Role of Organizational Context and Job Type for Future Study of Occupation-Based Secondary Trauma Intervention Development

Organizational context (e.g., criminal justice, community-based, and healthcare) and job type (e.g., police, social workers, and healthcare providers) may impact the extent of occupation-based secondary trauma (OBST). Survey data collected from a multiphase community-based participatory research project were analyzed from a variety of professionals, who were likely to "encounter the consequences of traumatic events as part of their professional responsibilities" (n = 391, women = 55%, White = 92%). Results document high trauma exposure (adverse childhood experiences [ACEs] and workplace) and OBST-related outcomes (Maslach Burnout Inventory, Secondary Traumatic Stress Scale, post-traumatic stress disorder symptom checklist for DSM-5) for the entire sample with important differences across organizational context and job type. Using multivariate regression, the strongest determinants of suffering, however, were not related to a provider's specific profession but to their number of years on the job and their ACEs (e.g., adjusted R2 = 0.23, b = 2.01, p < .001). Likewise, the most protective factors were not profession specific but rather the provider's age and perceived effectiveness of OBST-related training (e.g., b = 2.26, p < .001). These findings inform intervention development and have implications for rural and other often under-resourced areas, where the same OBST-related intervention could potentially serve many different types of providers and organizations.

The prevalence of and factors associated with depressive and anxiety symptoms during the COVID-19 pandemic among healthcare workers in South Africa

INTRODUCTION

Healthcare workers globally have experienced increased social and occupational stressors in their working environments and communities because of COVID-19 which has increased the risk of mental health concerns. This study aimed to explore the prevalence and correlates of depression and anxiety amongst healthcare workers during the COVID-19 pandemic in the Western Cape, South Africa. In addition, role-related stressors and coping strategies were explored.

MATERIAL AND METHODS

We conducted a cross-sectional survey of doctors and nurses working in public healthcare facilities across the Western Cape, South Africa. Participants completed the Generalized Anxiety Disorder-7 (GAD-7), the Center for Epidemiologic Studies Depression (CES-D), the Professional Quality of Life (PROQL-R-IV), and the Brief Coping Orientation to Problems Experienced (COPE-R) scales. Data were analysed using multivariable logistic regression analysis.

RESULTS

The sample comprised 416 health workers (303 nurses, 113 doctors). Almost 40% of the sample (n = 161) had CES-D scores suggestive of probable depression, and 45.9% (n = 186) had GAD-7 scores suggestive of anxiety. In the logistic regression model, the odds of probable depression were higher for female participants compared to men (OR = 2.26, 95% CI 1.00-5.10) and for participants who used behavioural disengagement as a coping strategy (OR = 1.50, 95% CI 1.14-1.97). More time spent working with COVID patients was associated with increased odds of having high levels of anxiety [OR = 1.13, 95% CI (1.02-1.25). Substance use (OR = 1.39, 95% CI 1.08-1.81), venting (OR = 1.31, 95% CI 1.01-1.70), and self-blame (OR = 1.42, 95% CI 1.08-1.87) were some of the coping strategies used by healthcare workers. High levels of secondary traumatic stress and burnout were found to increase the odds of both depression and anxiety.

CONCLUSION

Findings of this study suggest that there is a high prevalence of mental health issues among healthcare workers, and a critical need to focus on workplace mental health interventions to support these frontline workers.

Exploring key job demands and resources in Norwegian child mental health services: a cross-sectional study of associations with and relationship between compassion satisfaction, burnout, secondary traumatic stress and turnover intention

Background

Burnout, secondary traumatic stress, and high turnover rates among child mental health clinicians are a challenge, not only for the individual therapist and the organization but also for the successful implementation of evidence-based practices. However, little is known about which and how job-and implementation-related factors are associated with burnout, secondary traumatic stress, and turnover intention as well as compassion satisfaction among child therapists. In the present study, we aimed to explore these factors and related mechanisms by integrating the "professional quality of life" and the "job demands-resources" models of occupational health.

Methods

We measured the perceived professional quality of life and turnover intention among a national sample of 256 therapists working in Norwegian Child and Adolescence Mental Health Clinics (n = 44) that implemented Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Seventeen Job-and implementation-related resources and demands were also measured using the General Nordic Questionnaire for Psychological and Social Factors at Work and the Implementation Component Questionnaire. Path analysis was used to test whether burnout and compassion satisfaction mediate the relationship between job demands and resources on one hand, and secondary traumatic stress and turnover intention on the other hand.

Results and discussion

Results revealed that two job resources, i.e., positive challenges at work and mastery of work, were significant predictors of all professional outcomes. The proposed model was only partly supported. That is, while burnout did mediate the relationship between some job demands (i.e., work-family interference and role conflict) and job resources (i.e., human resource primacy, positive challenges, and mastery of work) with secondary traumatic stress and turnover intention, compassion satisfaction did not mediate the relationship between job resources and turnover intention. Moreover, in addition to their indirect effects via burnout, role conflict and organizational climate (human resource primacy) also directly affected turnover intention. These findings propose that interventions that reduce burnout should be prioritized to improve the professional quality of life and turnover intention among child therapists. Theoretically, it seems that compassion satisfaction and work engagement act differently.

The effect of the compassion levels of healthcare workers on their psychological well-being

BACKGROUND

A sense of compassion has a core importance in health service delivery. Research on the psychological impact of being compassionate on healthcare workers is limited.

OBJECTIVE

This research aims to examine the effect of compassion levels of healthcare workers on their psychological well-being.

METHODS

This was a cross-sectional and descriptive study. The population of the research consists of health personnel working throughout Ankara, the capital. The study was carried out with 414 healthcare workers. A personal information form, compassion scale and psychological well-being scale were used in the research questionnaire.

RESULTS

A positive and significant relationship was found between compassion and psychological well-being scores. It was determined that compassion positively affected psychological well-being levels. The level of compassion showed that there was a significant difference between the groups according to the variables of gender, family structure, job satisfaction and whether they would choose the same profession again. The level of psychological well-being was found to be significantly different between the groups in education, job satisfaction and making the same profession choice again.

CONCLUSION

It is a professional requirement that health professionals in patient care have a sense of compassion and reflect this feeling in their conduct. Research shows that the greater the compassion, the higher the psychological well-being. Therefore, undertaking training initiatives to make healthcare workers more compassionate can contribute to patient care and at the same time to the psychological well-being of healthcare workers.

Cross-Sectional Study of the Professional Quality of Life of Palliative Care Professionals during the COVID-19 Pandemic

BACKGROUND

The display of compassionate care by palliative care professionals is of the utmost importance to the patients, their families, and even to their own professional well-being. Lately and, especially due to the emergence of the COVID-19 pandemic, palliative care professionals have been subjected to greater pressures stemming from their work environment, organizational standpoint, and emotional sense of view. Not only have these factors made it harder for professionals to deliver compassionate care to their patients, but they have also decreased their overall well-being. The aim is to study how sociodemographics, workplace characteristics, internal resources, and the COVID-19 pandemic-derived pressures have affected the professionals' capacity to perform compassionate care and their well-being while at the same time exploring the relationship between compassionate care and well-being.

METHODS

This study used a cross-sectional design with data gathered from Spanish palliative care professionals. The final sample was formed by 241 participants. They were surveyed about compassion, professional quality of life, well-being, sociodemographic data, working conditions, self-care, and coping with death competence, and the impact of the COVID-19 pandemic. The analyses used were descriptive statistics, bivariate tests, and the construction of a structural equation model.

RESULTS

Compassion was predicted by the ability to control their workload and the ability to cope with death. Burnout was predicted by age, workload, workload control, self-care, material resources, and changes in teamwork. Moreover, compassion, age, workload control, and changes in teamwork and self-care were shown to significantly predict compassion satisfaction. When it comes to compassion fatigue, different variables were shown to predict it, those being compassion, control over the workload, social self-care, and the ability to cope with death.

CONCLUSIONS

Having a healthy lifestyle and an adequate social support system is key to maintaining professional well-being in the case of palliative care professionals. Inner resources such as the ability to perform self-care and the capacity to cope with death are of vital importance to taking care of these professionals. Thus, it would be beneficial to establish training programs focused on these aspects in the myriad of sanitary centers that perform these tasks, as these abilities are necessary to withstand the work-related pressures and, at the same time, be able to provide compassionate care for patients.

Rural health care worker wellness during COVID-19: Compassion fatigue, compassion satisfaction & utilization of wellness resources

OBJECTIVE

The goal of this study was to identify factors associated with compassion fatigue (CF) and compassion satisfaction (CS) among rural health care workers (HCWs) during the COVID-19 pandemic. The secondary purpose was to assess utilization of wellness resources and preferences for new resources.

METHODS

A survey was distributed (October-December 2020) and completed by faculty, clinicians and staff (n = 406) at a rural university. Measures included a modified version of the Professional Quality of Life Scale (PROQOL-21), the Patient Health Questionnaire-4 and the Brief Resilience Coping Scale. Respondents reported their use of wellness resources and their preferences for new resources.

RESULTS

The mean CF score was 21.1, the mean CS score was 26.8 and 42.0% screened positive for depression or anxiety. Few of the existing wellness resources were utilized and respondents' preferences for new wellness resources included time off (70.7%), onsite food trucks (43.0%) and support animals (36.5%). Younger age, depression and anxiety were associated with higher CF. Older age, better mental health and resilience were associated with higher CS.

CONCLUSIONS

Rural HCWs have high CF, yet few utilize wellness resources. Rural health care organizations may foster wellness by providing time off for self-care, expanding mental health services and building resilience.

The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.

Compassion Fatigue as a Self-Fulfilling Prophecy: Believing Compassion Is Limited Increases Fatigue and Decreases Compassion

People's compassion responses often weaken with repeated exposure to suffering, a phenomenon known as compassion fatigue. Why is it so difficult to continue feeling compassion in response to others' suffering? We propose that people's limited-compassion mindsets-beliefs about compassion as a limited resource and a fatiguing experience-can result in a self-fulfilling prophecy that reinforces compassion fatigue. Across four studies of adults sampled from university students and online participant pools in the United States, we show that there is variability in people's compassion mindsets, that these mindsets can be changed with convincing information, and that limited-compassion mindsets predict lower feelings of compassion, lower-quality social support, and more fatigue. This contributes to our understanding of factors that underlie compassion fatigue and supports the broader idea that people's beliefs about the nature of emotions affect how emotions are experienced. Together, this research contributes to developing a strategy for increasing people's capacity to feel compassion and their social support.

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

Burnout in mental health services in Ireland during the COVID-19 pandemic

BACKGROUND

Burnout is a consequence of chronic occupational stress. Specific work-related factors may contribute to burnout experienced by those working in mental health services (MHS), many of which have increased since the COVID-19 pandemic.

AIMS

To examine personal, work- and patient-related burnout among MHS staff in Ireland during the COVID-19 pandemic, and explore the impact of work-related conditions on burnout.

METHOD

We conducted a cross-sectional survey of three MHS across Ireland utilising a study-specific questionnaire, the Copenhagen Burnout Inventory and the Effort-Reward Imbalance scale.

RESULTS

Of 396 participants, 270 (70.6%) were female. Moderate and high personal burnout was experienced by 244 (64.1%) participants; work-related burnout by 231 (58.5%) participants and patient-related burnout by 83 (21.5%) participants. Risk factors for both personal and work-related burnout were female gender, urban service, time spent outside main responsibilities, overcommitment, high score on the Effort-Reward Imbalance scale and intention to change job. Being younger, with high workload and deterioration of personal mental health during the pandemic was associated with higher personal burnout, whereas a lack of opportunity to talk about work-related stress contributed to work-related burnout. Fewer factors were associated with patient-related burnout, namely overcommitment, working in urban services and poorer physical and mental health during the COVID-19 pandemic.

CONCLUSIONS

High levels of personal and work-related burnout were found among mental health workers. The weak association with COVID-19-related factors suggest levels of burnout predated the pandemic. This has implications for MHS given the recognised additional work burden created by COVID-19.

Career optimism and job-related well-being of Australian nurses during COVID-19: A cross-sectional study

BACKGROUND

Australia has been confronted with a severe nursing deficit, making it difficult to maintain a strong healthcare workforce capable of meeting the mounting demands of healthcare organizations.

AIMS

This study aimed to understand how personal and organizational resources influence career optimism and job-related affective well-being of Australian nurses during a pandemic using the Conservation of Resource Theory.

METHODS

A cross-sectional online survey was emailed to 123 Australian nurses from January to February 2021. The survey consisted of self-reported measures, including mindfulness, career optimism, job-related affective well-being, personal and job resources measures, and the Dirty Dozen scale. Correlations, independent sample t-test, and a series of hierarchical regressions were conducted on the cross-sectional data with SPSS Version 27. The STROBE checklist was used to report the results.

RESULTS

Findings suggested that mindfulness, perceived supervisor support, and job autonomy were significant predictors of job-related well-being, whereas mindfulness, perceived supervisor support, and opportunities for professional growth contributed more to career optimism of nurses during a health crisis. Male nurses in this study reported significantly higher mindfulness, career optimism, and job-related well-being levels than female nurses.

LINKING EVIDENCE TO ACTION

Developing mindfulness among nurses, allocating organizational resources to facilitate more supervisor support, and providing job autonomy may enhance career optimism and job-related well-being of nursing staff who work in disruptive and high-demand work environments such as those experienced during the COVID-19 health crisis. Supervisors should also facilitate and encourage nurses to reflect and be mindful of their behaviors with their peers and patients which can help to reduce exploitative or arrogant behaviors in the workplace.

Compassion fatigue in the community nursing workforce: a scoping review

BACKGROUND

compassion fatigue is a phenomenon in areas of nursing practice such as oncology, ICU, palliative care, hospice, and dementia care, but less so among community nurses (Joinson, 1992). A gap in enquiry exists around CN and compassion fatigue around end-of-life patient care.

METHODS

a scoping review with narrative analysis of selected literature on compassion fatigue in nursing using CINHAL, ProQuest, Science Direct, and the Cochrane Library.

FINDINGS

whilst no specific studies were located on compassion fatigue and UK community nurses. Australian, Spanish, and Taiwanese studies report of environment, care relationship duration, resources and poor organisational support being linked to a likelihood of developing compassion fatigue.

CONCLUSION

compassion fatigue is under-researched in community nursing and merits further enquiry to understand the challenges posed by providing end-of-life care.

Psychological Effects of Professional Exposure to Trauma and Human Suffering: Systematic Review and Meta-Analysis

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India

Background

Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals.

Methodology

This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used.

Results

More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS.

Conclusion

Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended.

How to cite this article

Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023;27(7):493-502.

Psychological distress among teaching staff during the COVID-19 pandemic: A transdiagnostic perspective on profiles of risk and resilience

Teaching staff are especially vulnerable to COVID-19-related stress, due to the significant demands they have experienced. Yet, many have shown resilience-good mental health despite stress exposure. The current study used a person-centered approach to identify distinct profiles according to individual differences in psychosocial risk and protective factors. Latent Profile Analysis and ANOVAs were employed among 350 Israeli teaching staff during the fourth wave of COVID-19. Two distinct profiles, "risk" (55%) and "resilience" (45%) were identified. While groups showed no differences in COVID-19-related stress outcomes, they consistently differed in their psychological reaction to COVID-19 (psychopathology, compassion fatigue, and compassion satisfaction).

Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners

Background

Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.

Objectives

This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.

Methods

Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software.

Results

Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.

Discussion

Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

Analysis of implementation drivers of secondary traumatic stress (STS)-informed organizational change and experiences of STS and burnout in child welfare

BACKGROUND

STS and burnout (BO) are significant problems for child welfare professionals (Bride, 2007; Craig & Sprang, 2010). A challenge for at-risk professions is to understand how both individuals and organizations can address the potential impact of these conditions.

OBJECTIVE

This study explores the influence of organizational factors on individual experiences of STS and BO in child welfare settings.

PARTICIPANTS AND SETTING

Study participants were 382 child welfare professionals in the United States who were participating in an organizational assessment of STS and related activities.

METHOD

The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) tool (Sprang et al., 2014) was administered to evaluate the use of policies, practices and training activities that address STS and BO (Sprang et al., 2014). The National Implementation Research Network's (NIRN) implementation framework was applied to the STSI-OA and domain activities loaded onto the three implementation drivers of competency, organization and leadership (Sprang, Ross, & Miller, 2018). Regression analyses were conducted to determine the strength of associations between the implementation drivers of STS informed organizational activity and individual ratings of STS and BO.

RESULT

Increased use of STS-informed activities affiliated with all three implementation drivers was significantly associated with lower individual STS and BO scores. STS-informed activities associated with the organization driver seemed particularly effective for addressing STS.

CONCLUSION

This study supports the utility of the integrated framework for enacting STS-informed change in child welfare contexts. Recommendations for organizations and future research are provided.

Compassion as a Source of Satisfaction and Fear in Professionals Who Work With People

BACKGROUND

Compassion satisfaction and fear of compassion affect the mental health of professionals who work with people. In addition, each of these two variables can be important indicators of the quality of the services such professionals provide.

METHODS

This study examines compassion as a source of satisfaction and fear among 293 professionals work with people, including 158 teachers, 57 police officers, 45 nurses and 44 imams. A personal information form, the Fear of Compassion Scale, and the Compassion Satisfaction Scale were used as data collection tools.

RESULTS

Neither fear of compassion nor compassion satisfaction varied significantly according to the sampled professionals' genders, educational levels, monthly incomes or area of residence. However, both these measures did exhibit statistically significant variation by the respondents' professional roles, ages, numbers of children and marital statuses. A significant negative relationship between the participants' fear of compassion and their compassion satisfaction was also identified.

CONCLUSION

Courses related to kindness and social interaction should be provided in schools, to help the adults of the future.

[Psychological impact of involvement of medical and psychological emergency unit professionals in the medical and psychological care system of the COVID-19 epidemic]

Objectives

COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system.

Method

In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place.

Results

Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction.

Conclusion

Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.

Addressing challenges at the intersection of early intervention and child welfare

BACKGROUND

The Keep Children and Families Safe Act amendment to the Child Abuse Prevention and Treatment Act (CAPTA) of 2003 mandated children under age three who are involved with Child Welfare (CW) to receive a referral to the system for early intervention (EI). While there is strong rationale for providing developmental services to young children and families impacted by maltreatment, the early implementation of this policy brought about many challenges related to interagency coordination and readiness of providers to provide cross-systems care. Currently, as the system and providers within the system recover from the effects of Covid-19, a predicted increase in need of services may exacerbate historical gaps in the provision of services to families involved with CW.

PARTICIPANTS AND SETTING

This policy-focused paper explores issues impacting CW and EI providers who coordinate care between CW and EI services.

METHODS

This paper provides a historical examination of these challenges and proposes an approach for improving developmental services for families referred from CW, specifically through the lens of addressing resources and supports available to providers.

RESULTS

The proposed approach includes an increase and reprioritization of resources to support provider readiness and well-being.

CONCLUSIONS

By focusing on support for providers, the authors propose a reduction of stress and improvement of services at each level of the "well-being" system.

Compassion Satisfaction, Occupational Stress, Burnout Syndrome, and Resilience Among Experienced Audiologists

OBJECTIVE

The aim of the research was to provide insight into compassion satisfaction (CS), resilience, burnout syndrome (BOS), and overall occupational stress levels of experienced audiologists.

DESIGN

This study was based on a four-part online questionnaire consisting of the Audiology Occupational Stress Questionnaire, the Professional Quality of Life Scale (Version 5), the Connor-Davidson Resilience Scale-10, and demographic questions.

STUDY SAMPLE

Fifty-nine audiologists with more than 5 years of experience completed the survey. Clinicians were from New Zealand, Australia, South Africa, the United States, Hong Kong, Israel, Singapore, and the United Kingdom.

RESULTS

The findings illustrate that no audiologists experienced high BOS or low CS scores. Positive correlations existed between resilience and CS and between BOS and overall occupational stress. Negative correlations were found between resilience and BOS, BOS and CS, CS and overall occupational stress, and resilience and overall occupational stress. Resilience (p = .015), CS (p < .001), and overall occupational stress (p < .001) were identified as being significant predictors of BOS. The top five occupational stressors for audiologists were reported as being staff shortages, administration duties, paperwork and patient reports, patient or family expectations to fix a client's hearing, and the amount time available with each patient. The differences in occupational stress experienced by private versus public audiologists were minimal, always being below 1 Likert point.

CONCLUSIONS

Although audiologists do not report high levels of BOS, they report stress in their workplace. As stress was a significant predictor of BOS, audiologists could benefit from interventions aimed at reducing workplace stress.

A Secondary Traumatic Stress Reduction Program in Emergency Room Nurses

Introduction

Secondary traumatic stress is highly prevalent among nurses, especially among nurses working within the emergency department (ED). Reducing healthcare worker secondary traumatic stress is important for ensuring the delivery of high quality, safe patient care. This paper reports on the development and implementation of a secondary traumatic stress reduction program.

Methods

We used an adaption of a 5-week intervention based on the Accelerated Recovery Program to test whether there would be a reduction in secondary traumatic stress in a pilot sample of nine ED nurses. Outcomes were assessed using the Secondary Traumatic Stress Scale (STSS), Somatic Symptoms Scale (SSS), and Compassion Satisfaction subscale (CSS) measures.

Results

Eight of nine nurses were able to complete at least three of the five sessions. Results indicate significant change in STSS (F[5,23]  =  4.22, p  =  .007) and SSS (F[3,15]  =  4.42, p  =  .02) scores, but not CSS (F[5,23]  =  0.83, p  =  .54) scores. Pairwise comparisons revealed that the beneficial effects of the program happened early. For both STSS and SSS, scores at sessions 1 and 2 were generally higher than subsequent sessions. We also found a trend for continued effects on STSS at a four-month follow-up (t₂₃  =  1.95, p  =  .064).

Conclusion

Overall, results indicate the 5-week program was associated with a significant reduction in secondary traumatic stress and related somatic symptoms in healthcare workers.

Work From Home or Bring Home the Work? Burnout and Procrastination in Brazilian Workers During the COVID-19 Pandemic

OBJECTIVE

To investigate burnout and procrastination in a sample of Brazilian workers during the COVID-19 pandemic according to their current work mode.

METHODS

This cross-sectional study used data from an online survey conducted in 2020: 435 workers were included. The Copenhagen Burnout Inventory and the Irrational Procrastination Scale were used to access burnout and procrastination respectively.

RESULTS

There was no difference between workers working from home (WFH) and at face-to-face work regarding burnout symptoms. However, the WFH group had higher levels of procrastination. Clinically significant levels of burnout were associated with being female, increased childcare load and living with children under 12years old.

CONCLUSIONS

WFH may have more advantages than disadvantages in ideal conditions. However, work-life imbalances seem to be a key aspect regarding distress among workers WFH, especially in women with small children.

Predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations: A scoping review

INTRODUCTION

A better understanding of the predictors of compassion satisfaction and compassion fatigue in health care workers in rural and remote communities is needed to inform preventative interventions for this sector of the health workforce.

OBJECTIVE

To identify predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations.

DESIGN

A scoping review informed by Arksey and O'Malley's five-stage framework and the scoping review protocol of the PRISMA-ScR statement.

FINDINGS

The search yielded 946 articles, and 34 full texts were screened for eligibility, leaving 12 studies meeting the inclusion criteria. No studies on workers providing rehabilitation services were identified. Three studies assessed possible predictors of compassion satisfaction and compassion fatigue in health care workers, and all studies evaluated burnout. The most studied predictor variables were age, gender, profession and workload.

DISCUSSION

This study identified potential risk and protective factors for health care workers that are likely relevant to those providing rehabilitation services in rural locations. Little is known about possible predictors of compassion satisfaction and compassion fatigue in professionals working in rural and remote areas outside of medicine and nursing or health care workers in rural community-based settings.

CONCLUSION

Research examining predictors of compassion satisfaction and compassion fatigue in rehabilitation health care workers working in rural and remote locations is scant. Research that identifies risk and protective factors in this rapidly growing sector of the health care workforce is needed to inform the development of interventions that promote professional quality of life.

A gratitude intervention to improve clinician stress and professional satisfaction: A pilot and feasibility trial

OBJECTIVE

Resilience training combined with medical system changes have the potential to reduce clinician burnout. We sought to estimate effects and assess feasibility of a brief gratitude intervention for primary care clinicians.

METHODS

This was a pre-test/post-test single group intervention design with longitudinal follow-up. Volunteer participants were from either a primary care community engagement conference or worked at one of two clinical sites in a Western mid-size city. Eligible clinicians held an MD/DO or NP/PA degree and currently worked at least 0.50 FTE in a primary care clinical practice and were willing and able to participate in the initial group session and complete weekly journaling. The gratitude intervention consisted of an in-person 90-minute group psychoeducation and skills-building workshop, followed by an 8-week daily gratitude journal exercise. The primary outcomes were related to resilience, including coping self-efficacy, clinician autonomy, and self-care behaviors. The secondary outcomes were the feasibility and acceptability of the intervention, as well as career satisfaction, and types and frequency of things for which clinicians were grateful in their daily work.

RESULTS

The intervention was brief, feasible, and of interest to clinicians. Statistically significant improvements were seen in most outcome measures at both 4 and 8 weeks follow-up, with the exception of gratitude, which also increased, but not significantly so. Gratitude categories mentioned most frequently were support platforms at work (47%) and sense of competence (42%).

CONCLUSIONS

The intervention had positive effects on resilience and is a promising brief intervention for clinicians experiencing stress. Larger experimental designs are needed.

Professional quality of life in home visitors: Core components of the reflective supervisory relationship and IMH-E® Endorsement® engagement

Infant and early childhood home visiting models are gaining prominence as effective programs for families. Most U.S. state infant mental health associations (IMHAs) recommend reflective supervision (RS) and Infant Mental Health (IMH-E^® ) Endorsement^® as components of home visitor professional development. These efforts may promote workforce professional quality of life. It is unknown whether a workplace policy to provide RS improves the likelihood that best practice guidelines, especially core components of a reflective supervisory relationship, are experienced by the workforce. We sought to investigate associations between home visitor well-being indicated by professional quality of life (i.e., burnout, secondary traumatic stress, compassion satisfaction) and a workplace policy providing RS, consistent experience of core components of a reflective supervisory relationship, and engagement in endorsement. We also examined differences in consistently experiencing core components of the reflective supervisory relationship in home visitors who reported having a workplace policy for providing RS and those who did not, and for home visitors engaged or not engaged in the endorsement process. A Workplace Supports Survey was designed to investigate these associations; we report findings from a sample of home visitor respondents (N = 139).  A policy to provide RS was not associated with professional quality of life. However, analyses suggest an association between a policy to provide RS and consistently experiencing core components of a reflective supervisory relationship. Unanticipated positive associations between engagement in endorsement and burnout and secondary traumatic stress were also found. Finally, engagement in endorsement was associated with less consistent experience of these core components. Implications for future inquiry about the purposes of RS and IECMH Endorsement^® as strategies to promote workforce development and well-being are discussed.

The contribution of organisational factors to vicarious trauma in mental health professionals: a systematic review and narrative synthesis

BACKGROUND

The negative impact of trauma work has been well documented in mental health professionals. There are three main phenomena used to describe these effects: Secondary Traumatic Stress (STS), Vicarious Trauma (VT) and Compassion Fatigue (CF). To date, the majority of research has focused on the contribution of individual level factors. However, it is imperative to also understand the role of organizational factors.

OBJECTIVES

This review examines the role of organizational factors in ameliorating or preventing STS, VT, and CF in mental health professionals. We further aimed to identify specific elements of these factors which are perceived to be beneficial and/or detrimental in mitigating against the effects of STS, VT, and CF.

METHOD

Studies were identified by searching the electronic databases Medline, PsycINFO, Embase, Web of Science and SCOPUS with final searches taking place on 10 March 2021.

RESULTS

Twenty-three quantitative studies, eight qualitative studies, and five mixed methods studies were included in the final review. A narrative synthesis was conducted to analyse the findings. The results of the review highlight the importance of regular supervision within supportive supervisory relationships, strong peer support networks, and balanced and diverse caseloads. The value of having an organizational culture which acknowledges and validates the existence of STS was also imperative.

CONCLUSIONS

Organizations have an ethical responsibility to support the mental health professionals they employ and provide a supportive environment which protects them against STS. This review provides preliminary evidence for the types of support that should be offered and highlights the gaps in the literature and where future research should be directed. Further research is needed to evaluate which strategies - and under what conditions - best ameliorate and prevent STS.

Felt Needs of Cancer Palliative Care Professionals Working in India: A Qualitative Study

Objectives:

Cancer palliative care professionals face a plethora of challenges related to death, dying and suffering apart from limited workforce and other resources in India. However, the grief held by them is underappreciated and psychological needs are under explored. The aim of the present study was to explore felt needs of cancer palliative care professionals working in India.

Materials and Methods:

The study was cross-sectional, qualitative and in-depth in nature. It was conducted across four cancer palliative care centers in Bengaluru city of India. sample consisted of 15 professionals (mean age = 42 years and standard deviation = 8.41) with at least six months of experience, involved in direct patient care who gave an additional consent for audio-recording. The tools used were sociodemographic and professional datasheet and semi-structured interview guide, which were developed for the present study and validated from five experts. Thematic analysis was used to generate and analyze patterns within the qualitative data.

Results:

Five themes were identified, namely, death and grief; challenges in practice; strategies for self-care; positive professional experiences; and vision for palliative care.

Conclusion:

The cancer palliative care professionals need regular support in coping with death and grief, regular trainings and supervision across workplace to deal with occupational challenges, and to address their self-care and spiritual needs. The study highlights need to introduce more specialized training courses in handling pediatric patients, increase palliative care workforce, and hospice units. This can have implications in future research and training with development of innovative interventions to address these needs and challenges.

Trauma informed care education for midwives: An integrative review

BACKGROUND

Nearly half of new mothers describe their childbirth as traumatic. Perinatal trauma impacts both short and long-term biopsychosocial outcomes for mother and child. Midwife trauma-informed care education and practice is essential to mitigate this risk.

OBJECTIVE

This review aimed to identify and describe the nature and extent of trauma informed care education provided for midwives and midwifery students.

DESIGN

An integrative review.

METHODS

Five databases (Medline, Embase, CINAHL, Psycinfo, and Emcare) were searched to identify primary research regarding trauma informed care education for midwives and midwifery students. Quality appraisal was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Three papers were identified. None of the papers were midwifery focused, with midwives representing a small proportion of the participants. Most midwives reported receiving no previous trauma informed care education and lacked confidence to provide quality care to women with lived trauma. Midwives reported trauma informed care education as essential and relevant for providing quality practice. Improvements in knowledge, skills and attitudes was demonstrated following trauma informed care education. More in-depth content and content delivered in multiple ways were recommended.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwives are well placed to deliver trauma informed care. Trauma informed care education for midwives is limited. Given the impact of perinatal trauma, further trauma informed care education and research is paramount.

The Role of Empathy in Professional Quality of Life: a Study on Australian Police Officers Working in Sexual Assault and Child Abuse Investigation

Police working in sexual assault and child abuse investigation may be at risk of secondary trauma effects and burnout, particularly if they do not have protective mechanisms in place. Empathy has shown to be vital in protecting against secondary trauma and burnout, as well as enhancing compassion satisfaction. The current cross-sectional study surveyed 216 Australian police participants working in sexual assault and child abuse investigation exploring the relationship between different facets of empathy and professional quality of life factors. All facets of empathy predicted compassion satisfaction and negatively predicted burnout. Aspects of cognitive empathy negatively predicted burnout and secondary traumatic stress, while aspects of emotional/physiological and cognitive empathy positively predicted compassion satisfaction. Novel gender differences were found, with males at higher risk of burnout; tenure significantly predicted burnout and secondary traumatic stress; and results supported that empathy is a vital mechanism for sustaining wellbeing, satisfaction, and efficacy in this work.

Well-Being at Work: A Cross-Sectional Study on the Portuguese Nutritionists

This exploratory, nationwide cross-sectional study was performed to investigate the well-being of Portuguese nutritionists, in addition to outlining their professional and demographic profile. Descriptive analyses were carried out to determine the measures relating to centralising tendency and dispersion of the sample. We compared means and proportions through t-tests and Analysis of Variance (ANOVA). The sample size was 206 individuals, respecting a minimum of eight respondents per item to validate the instrument. We recruited Nutritionists from Portugal nationwide using the list of electronic mail provided by the Order of Nutritionists. We sent an electronic mail to all the Nutritionists registered in this Order. We also used messaging applications and social networks (Instagram, Facebook) to reach Nutritionists who were not accessing electronic mail. Most respondents are women (92.5%), young (mean age = 31.4 ± 8.07 years; 54.2% of participants aging under 30 years), single, and with no children. More than half are Catholic (73.8%) and have less than ten years of nutritionist undergraduate completion (55.4%). The only variable that influences well-being at work is the economic variable Household Monthly Income. Those who earn less than €500.00 per month perceive themselves at a lesser state of work well-being than those who earn from €2501.00 to €5000.00 per month.

The Personal Wellbeing Index in Spanish Palliative Care Professionals: A Cross-Sectional Study of Wellbeing

Health professionals are especially exposed to stress, with consequences on professionals’ health and wellbeing. However, palliative care professionals’ wellbeing has been the subject of very little research. The aim of this work is to study the Personal Wellbeing Index (PWI) in a sample of Spanish palliative care professionals, as well as to study their levels of wellbeing and the relationships of wellbeing with variables such as gender, age, marital status, profession, and professional quality of life. A cross-sectional survey of Spanish palliative care professionals was conducted. The Spanish version of the PWI and the Short version of the Professional Quality of Life Scale were used. Here, 296 palliative care professionals attending patients at the end of life participated in the study. They showed medium to high levels of wellbeing. The PWI showed an adequate internal structure [χ²₍₂₀₎ = 116.130 (p < 0.001)]; Comparative Fit Index (CFI) = 0.970; standardized root mean square residual (SRMR) = 0.041; root mean square error of approximation (RMSEA) = 0.140 (0.116, 0.166)] and excellent estimates of reliability [α = 0.879 and Composite Reliability Index (CRI) = 0.923]. Wellbeing was higher for married compared to single and showed no relation with age, gender, and profession. Additionally, a structural equation model was estimated, in which a positive relation was found between wellbeing and compassion satisfaction and a negative one with burnout. The PWI is adequate to measure personal wellbeing in Spanish palliative care professionals.

The Impostor Phenomenon in Mental Health Professionals: Relationships Among Compassion Fatigue, Burnout, and Compassion Satisfaction

Imposter phenomenon is defined as a sense of intellectual fraudulence and an inability to internalize success and competency. Although imposter phenomenon has been noted in several populations, literature is sparse that focuses on mental health professionals. In addition, little is known about the relationships between imposter phenomenon, compassion fatigue, and compassion satisfaction for mental health workers. Using a survey design with a convenience sample of 158 mental health workers, this study found that imposter phenomenon was positively associated with compassion fatigue, as well as negatively associated with compassion satisfaction, when controlling for years of work and age. Further, the combination of lower levels of compassion satisfaction and higher levels of burnout predicted higher levels of imposter phenomenon. Implications and preventative measures are discussed.

Working in the Field of Complex Psychological Trauma: A Framework for Personal and Professional Growth, Training, and Supervision

The aim of this article is to explore the positive and negative impacts of working therapeutically in complex psychological trauma (CPT), particularly the field of gender-based violence (GBV) and childhood sexual abuse (CSA), from the clinicians' perspective. The focus was on the prospect of positive gains and growth for therapists. Twenty-one clinicians (n = 21; counselors/psychotherapists and psychologists) from National Health Service (NHS) specialist trauma services, a community mental health team, and specialist sexual assault counseling organization participated. Interpretative phenomenological analysis (IPA) was utilized to conduct single one-off interviews and analysis. Six themes were identified: Called to the work; Connection, Separation, and Oneness; Into and out of the darkness; Chaos into meaning; Reparation not repetition; and Expansion and growth. The first "Therapist Led Framework of Growth in Trauma Work" is presented. Vicarious posttraumatic growth (VPTG) was a key finding, with CPT therapists experiencing a "challenge/benefit/change" growth process. Adoption of actively relational strategies to enhance clinicians' growth process through trauma work is being proposed. The benefits of conceptualizing both the positive and negative impacts of such work for supervision, training, shaping the formal curricula, service management, and continuing professional development (CPD) are being discussed. The need for good practice guidelines on self-care internationally is highlighted.

Professional values and professional quality of life among mental health nurses: A cross-sectional study

This study aims to investigate the relationship between the professional values and professional quality of life of nurses working in mental health units. This descriptive, cross-sectional, and correlational study was conducted with a sample of 120 nurses working in mental health units of one regional, one public, and one university hospital in western Turkey. Data were collected using an introductory information form, the Nurses Professional Values Scale-Revised, and the Professional Quality of Life-IV Scale. A statistically positive relationship was found between nurses' professional values, compassion satisfaction, and burnout. Nurses' professional values, education level, whether considering changing units, and allocation of time to social life were significant predictors of professional quality of life, explaining 44% of the total variance for Compassion Satisfaction and 24% for Burnout. Whether considering changing units was the most important predictor of compassion satisfaction, and truth value was the most important predictor of burnout. Nurses providing care based on professional values were found to have higher compassion satisfaction and burnout levels, and nurses with higher compassion satisfaction were found to experience less compassion fatigue.

Rape Crisis Counseling: Trauma Contagion and Supervision

This study of rape crisis counselors considers whether increased exposure to victims' trauma is associated with increased supervision-believed necessary to combat trauma contagion-and whether such supervision will reduce the negative impact of such exposure. One hundred six women counselors in seven of nine rape crisis centers in Israel completed anonymous questionnaires documenting their work and trauma exposure. Trauma exposure was defined by counselors' number of victim-contact hours per week and their assessment of the trauma severity they experienced. Supervision was measured by the number of hours received. Counselors trauma outcome indicators included sexual intimacy, secondary traumatization (evidenced in posttraumatic stress disorder [PTSD]-type symptomology), and vicarious traumatization (expressed as a disturbance in cognitive schemes that undermine the self and others). Hypotheses were evaluated in fully recursive path analyses via ordinary least squares (OLS) regression. Participants' mean age was 43.4 years; 58% were married, 26% single, 13% divorced, and 3% widowed; 81% had a college degree or more; 18.9% reported being exposed to victims-trauma at a minimal level, 54.7% moderate and 26.4% extreme; and 43.4% were abused at some time in their lives. Job exposure to victims' trauma was significantly associated with increases in supervision time (β = .33, p = .002). Supervision time fully mediated the relationship between duration of exposure to victims' trauma and counselors' secondary traumatization reports such that increased supervision was associated with degrading sexual intimacy (β = .22; p = .032) and increased Secondary Trauma Scale scores (β = .44; p = .004) after taking into account counselors' education level, history of abuse, anger management in intimate relationship, and posttraumatic growth scores. The study results raise concern about counselors' mental health in that the supervision effect exacerbated the trauma contagion impacts. The study suggests a need for documenting the nature of the supervision and considering different types of supervision methods.

Mental Health and Work Experiences of Interpreters in the Mental Health Care of Refugees: A Systematic Review

Background: Interpreters often play a crucial role in the health care of refugees. Although interpreters working with refugees are regularly confronted with emotionally stressful content, little is known about their work-related stress and psychological well-being. Primarily qualitative studies indicate increased emotional stress in interpreters, and difficulties in handling the traumatic content from their clients. Additionally, the working conditions of interpreters appear to be demanding, due to low payment and a lack of supervision or adequate preparation. Objective: The presented systematic review aimed to identify and summarise quantitative and qualitative research on the mental health of interpreters in the mental health care of refugees. Method: A systematic search was performed in five databases, and specific interpreting journals were searched. After removal of duplicates, 6,920 hits remained. Eligible studies included quantitative, qualitative, and mixed-methods studies as well as case studies and grey literature. The studies aimed to examine mental health aspects or work experiences of spoken language interpreters in mental health care settings for adult refugees. Results: Altogether, 25 studies were identified, including six quantitative and 19 qualitative studies. Studies were analysed and presented narratively. In the analysis of the qualitative studies, three themes emerged: "Emotions, behaviour, and coping strategies," "Working in a triad," and "Working environment." In the quantitative studies, interpreters showed heightened levels of emotional stress and anxiety, and secondary traumatic stress reactions. In several qualitative studies, interpreters described a devaluing health care system and stressful working conditions with a lack of support structures. Conclusion: Overall, the results indicate a high level of stress among interpreters working with refugees. Quantitative data are sparse, and studies employ heterogeneous assessments in diverse study settings. Therefore, future quantitative research is necessary to consistently investigate interpreters' mental health in different mental health care settings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42019117948.

Vicarious traumatization among child welfare and child protection professionals: A systematic review

BACKGROUND

Many individuals and organizations experience vicarious trauma, defined as exposure to traumatic experiences of others. Those who work with children traumatized by abuse and/or neglect, including, but not limited to, child welfare, child protection, counselors, healthcare providers, advocates, law enforcement, and prosecutors investigating crimes against children, are exposed to traumatic stories daily in their work. Negative reactions to this witnessing of other people's trauma results in vicarious traumatization (also referred to as secondary traumatic stress) which can manifest as mental, physical, emotional, spiritual, work-related and/or social consequences.

METHODS

A review of research literature on the epidemiology of vicarious traumatization among child welfare professionals was conducted. A systematic search strategy was employed using relevant research databases (PubMed, PsychInfo, PILOTS, and EBSCO) for publications from 1995 to 2018. A four-phase PRISMA selection process was employed. Search terms included vicarious trauma/related terms and child welfare/child protection professions. Trained reviewers considered articles meeting inclusion criteria including: (1) child welfare professions; (2) vicarious traumatization/related terms; and (3) analysis of epidemiological data on prevalence, risk/protective factors, or manifestation of vicarious traumatization.

RESULTS

Initially 7,895 unique manuscripts were identified. After multi-stage screening, a total of 39 articles were included. Findings regarding the epidemiology of vicarious traumatization are summarized.

CONCLUSIONS

While exposure to traumatic narratives of those they serve is inevitable for those working in child welfare and child protection professions, the growing research base shows potential for preventing negative impacts and promoting positive outcomes of this empathic work. Identification of additional risk/protective factors and future development and evaluation of evidence-based interventions are important next steps.

Professional quality of life and intent to leave the workforce: Gender disparities in child welfare

BACKGROUND

Efforts to enhance professional quality of life (ProQOL) may prove a promising area for intervention to reducing workforce jettison and maintaining a healthy and resilient workforce necessary for supporting children and families in the child welfare system.

OBJECTIVE

The current study aimed to describe the relative contributions of measures of ProQOL to intent on leaving the workforce among child welfare professionals. We also aimed to describe gender differences in ProQOL, intent to leave, and associated correlations among child welfare professionals. Such an investigation is a critical extension of earlier efforts as women constitute a markedly larger proportion of the workforce compared to men and evidence exists pointing to gender disparities in helping professionals' work experiences.

PARTICIPANTS AND SETTING

Secondary data were used from a survey of child welfare professionals across five sites.

METHODS

Univariate and bivariate statistics, hierarchical linear regression, and associated z-scores and p-values were used to meet the aforementioned aims.

RESULTS

Burnout accounted for the greatest variation in intent to leave among all professionals. However, gender disparities were found for all ProQOL measures with the largest difference observed for burnout, an effect more pronounced in males. Compassion satisfaction was significantly higher among females.

CONCLUSIONS

Burnout shapes intentions to leave for child welfare professionals; however, the effects of emotional exhaustion and hopelessness are stronger predictors of turnover among male than females in the current sample. Organizational strategies to reduce burnout and future research directions are discussed.

Inclusion of the homeless in health equity curricula: a needs assessment study

Exposure to homeless patients is a potential strategy to teach about social determinants of health and health inequities. Little is known about student attitudes and preferences for learning about the homeless in curricula addressing vulnerable populations. A needs assessment to determine student readiness may inform strategies for teaching. A mixed-methods study of one matriculating physician assistant student class, with a cross-sectional survey and 3 focus groups (FG). The validated 19-item Health Professionals' Attitudes Toward Homelessness inventory (HPATHI) and new 7-item Learning Attitudes scale were administered to explore perceptions and preferences about relevance of caring for the homeless to future practice. FGs were conducted to theme saturation. Verbatim transcripts were independently read and coded by 3 researchers using constant comparison. Survey response rate was 100% (N = 60). Overall HPATHI mean score was 3.97 ± 0.04 of 5, indicating positive attitudes toward the homeless. The highest mean score (4.26 ± 0.04) was for the social advocacy subscale; the lowest (3.02 ± 0.06) for personal advocacy. The Learning Attitude scale (Cronbach's alpha 0.89) mean score was 4.47 ± 0.07 out of 5, showing a positive attitude toward curricular exposure. Older students and those with prior experience with the homeless had higher HPATHI scores (p < 0.05). Four major themes emerged: vulnerable patients cannot advocate for themselves; learning about homelessness is relevant to future practice; preference for multiple teaching strategies and adequate preparation for street rotations; and anticipated anxiety about safety. Students recognize the value of learning from homeless patients as part of gaining skills in caring for vulnerable populations. Experiential learning opportunities focusing on this group are seen as an acceptable and valuable way to gain skills applicable to all vulnerable patients. Students express fear and anxiety around non-traditional settings such as the street. Their anxieties should be adequately addressed when designing clinical rotations.

In the trauma-informed care trenches: Teacher compassion satisfaction, secondary traumatic stress, burnout, and intent to leave education within underserved elementary schools

BACKGROUND

School-based trauma-informed care (TIC) represents a novel way of supporting children with trauma histories. However, minimal research has focused on how TIC impacts teacher wellbeing, which is concerning given the relationship between occupational stress and turnover from education.

OBJECTIVE

This study investigated teacher characteristics associated with perceived effectiveness of TIC and intent to leave education.

PARTICIPANTS AND SETTING

The study included 163 teachers in underserved elementary schools serving a high percentage of low-income, English-language learner Latinx students.

METHODS

Teachers completed a survey regarding an ongoing TIC program and quality of life for helping professionals.

RESULTS

Higher compassion satisfaction and secondary traumatic stress (STS), as well as lower burnout, were associated with perceived effectiveness of TIC. Older teachers, and those with lower compassion satisfaction and higher burnout, were more likely to report intentions to leave education. STS and perceived effectiveness of TIC were not associated with turnover intent.

CONCLUSIONS

Results suggest that teacher occupational wellbeing, particularly compassion satisfaction, plays a role in buy-in to TIC and retention among teachers.

Development and validation of the Short Professional Quality of Life Scale based on versions IV and V of the Professional Quality of Life Scale

Background

This research presents a short version of the Professional Quality of Life (ProQOL) scale, one of the most frequently used questionnaires in the arena of applied healthcare investigation. It measures burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS).

Methods

A 9-item version of the ProQOL was developed. In Study 1, this short version, which used items from version IV of the ProQOL, was administered to 817 palliative care professionals from Spain, Argentina, and Brazil. In Study 2, the same nine items, but this time from version V of the ProQOL, were administered to 296 Spanish palliative care professionals.

Results

Study 1: The Short ProQOL showed an adequate internal structure, and invariance across the countries studied (χ²(106) = 185.620 (p < 0.001), CFI = .929, RMSEA = 0.058 [0.044, 0.072], SRMR = 0.081). Argentinians showed higher levels of BO (mean difference = 0.172, p = 0.042, Cohen’s d = 0.168), whereas Brazilians showed higher levels of CF (Mean difference = 0.384, p = 0.002, Cohen’s d = 0.352). Study 2: the Short ProQOL again showed adequate internal structure and reliability (χ²(24) = 134.504 (p < 0.001); CFI = 0.953; RMSEA = 0.126 [0.106, 0.147]; SRMR = 0.063), and was related to coping with death, self-compassion, and self-care.

Conclusions

The Short ProQOL could help facilitate the application of harmonizing measurements and its use for cross-cultural comparisons and occupational health monitoring was satisfactory.

Burnout and secondary trauma among forensic interviewers

Child Advocacy Centers provide a child-friendly environment for the forensic interview and subsequent investigation of child victimization cases. However, very little research has examined the effects of burnout, secondary trauma and organizational stressors on forensic interviewers. The present study examined the following research questions. To what extent do forensic interviewers experience burnout and secondary trauma associated with their profession? How do organizational stressors increase these outcomes among interviewers? Data were collected by conducting an online survey of interviewers working at Child Advocacy Centers across the United States. Results indicate burnout and secondary trauma among interviewers in this sample. Decreased job support, increased funding constraints and heavy agency caseloads all result in burnout and secondary trauma. Policy recommendations include continued training and mental health services for interviewers. Future researchers should conduct qualitative interviews and examine how other factors, such as forensic interviewing protocols, influence interviewers' job experience and mental health.