Development of a Midwifery Student Peer Debriefing Tool: An interpretive descriptive study

BACKGROUND

Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences.

OBJECTIVE

To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma.

DESIGN

Interpretive descriptive methodology.

SETTING

This study was set at two Australian universities from which pre-registration midwifery courses are delivered.

PARTICIPANTS

The work of reviewing the original tool and adapting it for use by and with midwifery students associated with this project was conducted by a key stakeholder group of seven representative midwifery students and five midwifery academics.

METHODS

Ethics were approved. Data were collected via one face to face and two online conversations using the Microsoft Teams™ platform. Reflexive Thematic analysis were applied to revise the tool following each round of data collection and to finalise the adaptation of the intervention for its new intended purpose.

RESULTS

The Midwifery Student Peer Debriefing Tool is presented as a six-step intervention that guides the midwifery student through a process of debriefing with their peer. The feasibility of the tool resulted in an overarching theme labelled "I want this to mean something" and captures the therapeutic power of peer debriefing toward a meaningful outcome that fostered growth, and a deeper understanding of the profession.

CONCLUSION

Vicarious trauma is widely recognised as a core reason for midwives and midwifery students leaving the workforce. The peer debriefing tool helps midwifery students move through the process of recovering from adversity but also fostered learnings about midwifery practice and the profession.

Transforming Empathy-Based Stress to Compassion: Skillful Means to Preventing Teacher Burnout

Objectives

Teachers play a critical role in preparing our children and adolescents for a successful future. However, despite the large number of students impacted by trauma and adversity, teachers are often not well prepared to provide trauma-sensitive support. Furthermore, while working to support students exposed to trauma and adversity, teachers may experience empathy-based stress exacerbating already high levels of stress among them. This narrative review explores the issue of empathy-based stress within the context of the prosocial classroom model which proposes that teachers' social and emotional competence and well-being are key to their ability to create and maintain supportive learning environments critical to student academic and behavioral outcomes.

Methods

Recent findings in neuroscience and education research are applied to support teachers' development of these competencies.

Results

We propose that shifting from empathy-based stress to compassionate responding may be one such competency to help teachers' respond effectively to their students' needs while protecting their own wellbeing.

Conclusion

We review research that supports this proposition and explore implications for teacher professional learning, educational policy, and further research.

Integrating Gender-Based Violence Screening and Support into the Research Clinic Setting: Experiences from an HIV Prevention Open-Label Extension Trial in Sub-Saharan Africa

HIV and gender-based violence (GBV) are syndemic in sub-Saharan Africa and provision of support for participants who disclose GBV constitutes part of comprehensive care. Consequently, a process was undertaken to develop, implement, and evaluate standard operating procedures (SOPs) in MTN-025/HOPE, a study of the dapivirine vaginal ring for HIV prevention. The SOP was developed using needs assessment surveys in addition to World Health Organization (WHO) guidelines and other literature. Sites tailored and implemented the SOP through HOPE implementation. At study end, staff reported increased training 32/35 (91.43%); improved confidence (18/26; 69.23%); and improved vicarious trauma prevention onsite (17/28; 60.71%). Leadership reported increased staff competence in GBV response. Obstacles included limited referral organizations and time for follow-up, continued training needs, and cultural norms. Development and implementation of an SOP is a feasible strategy to build a GBV response to improve health systems and support sustained effective use of HIV prevention products.

Vicarious trauma on the hemodialysis healthcare workers in the besieged Ethiopia's Tigray region: a call to action

BACKGROUND

The war on Ethiopia's Tigray broke out on November 4, 2020. Amid the armed conflict, governmental institutions were destroyed, people were displaced, and thousands of civilians were killed. The region was experiencing an on-and-off type of blockade since the war broke out until June 28, 2021, at which time the federal government of Ethiopia imposed a siege cutting off the region from the rest of the world. Due to the shortage of medicines and medical supplies, witnessing deaths that otherwise were preventable under normal conditions has become the daily predicament of healthcare workers. The burden of healthcare disintegration is particularly carried by patients with chronic medical illnesses including patients on dialysis.

MAIN BODY

Ayder hospital, Tigray's flagship healthcare institution, hosts the only hemodialysis center in the entire region. This center is currently unable to give appropriate care to kidney failure patients for a lack of access to dialysis supplies and consumables due to the ongoing war and siege. This has resulted in vicarious trauma manifested with compassion fatigue, irritability, a feeling of bystander guilt; sadness about the patient's victimization, and hopelessness among healthcare workers caring for dialysis patients.

CONCLUSION

The suffering of veteran patients and witnessing preventable deaths have continued to haunt and torment healthcare workers in the dialysis unit leading to vicarious trauma. Cognizant of the fact that vicarious trauma has serious health ramifications on healthcare workers; we call up the international community to advocate for a full resumption of access to healthcare and the provision of mental health support and educate and train healthcare workers dealing with end-stage kidney disease patients on hemodialysis.

Secondary trauma, burnout and resilience among mental health professionals from India: A review of research

While globally there has been growing research interest in the negative psychological consequences faced by helping professionals, literature among Indian Mental Health Professionals (MHPs) is sparse, and predominantly focussed on health care workers. This systematic review aims to synthesize and summarize current Indian literature on burnout, secondary traumatic stress and resilience among Indian MHPs. The review explores 14 research studies published in peer-reviewed journals between January 2005 to January 2022. Studies in the areas of secondary traumatic stress, burnout, vicarious trauma, compassion fatigue, and resilience have been included in the review. The term resilience within this paper includes compassion satisfaction, vicarious post-traumatic growth, well-being, coping, and stress management. The mental health professionals considered were psychiatrists, psychiatric nurses, psychiatric social workers, clinical psychologists, psychotherapists and counsellors. Studies were reviewed for their methodological considerations, the mental health population being studied, and the primary outcomes. Data related to sociodemographic variables, psychological impacts, risk and protective factors that influence burnout, secondary trauma and resilience among mental health professionals in India have been reported. The review summarizes conceptual, methodological, and analytical gaps and generates recommendations that contribute to theoretical and practice-based improvements in this area of research and practice.

Psychosocial impacts of training to provide professional help: Harm and growth

Introduction

Research has consistently demonstrated professionals in helping roles ("helping professionals") experience vicarious trauma, moral injury, compassion fatigue, secondary traumatic stress, and burnout. Vicarious post-traumatic growth has also been identified in the literature. This article aimed to contribute to understanding the experiences of these constructs of trainee helping professionals. Emphasis was placed on how to foster vicarious post-traumatic growth.

Methods

A qualitative semi-structured interview was designed to enable the researchers to explore the experiences of 14 trainee psychologists from an Australian Master of Clinical Psychology program.

Results

It was identified that burnout, and beginning stages of vicarious trauma, moral injury, compassion fatigue, and secondary traumatic stress might occur during psychologists' training. Five elements underpin vicarious post-traumatic growth, four of which were reflected in this article. A need and suggestions for how to further develop vicarious post-traumatic growth are discussed.

Conclusion

This research could go on to be applied to curriculum development and practice policy, ultimately leading to improved early-intervention and ongoing systems of support for helping professionals. This, in turn, would improve quality of care in communities.

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.

Victimology from clinical psychology perspective: psychological assessment of victims and professionals working with victims

Victimology concerns victims of various traumas from accidents, disasters, assaults to wars. Survivors of trauma are also an area in clinical psychology since it is interested in the assessment and diagnosis of psychopathology and psychotherapy. Stress and mental health are intertwined; increased stress results in difficulties in feeling, thinking and behaving. The stress symptoms are an intrusion, avoidance, negative cognitions and mood, and arousal and reactivity. A trauma survivor might develop post-traumatic stress disorder. Healing trauma is so comprehensive that many professionals work from different aspects. From attorneys to mental health workers, many professionals deal with the aftereffects of trauma. Engaging with details of the trauma endangers not only the victims but also the professionals working with the victims. These professionals end up having psychological effects such as secondary trauma, vicarious trauma, compassion fatigue, countertransference and occupational burnout. Trauma has serious effects on its victims but not all effects are negative and paralyzing. Trauma victims might change their priorities in a way that they report more personal control over their life. This phenomenon is called posttraumatic growth. The paper aims to collaborate victimology with clinical psychology by highlighting psychopathology and psychological assessment.

Intersectionality and Invisible Victims: Reflections on Data Challenges and Vicarious Trauma in Femicide, Family and Intimate Partner Homicide Research

Rigorous, comprehensive and timely research are the cornerstone of social and transformative change. For researchers responding to femicide, family and intimate partner homicide, there are substantial challenges around accessing robust data that is complete and fully representative of the experiences and social identities of those affected. This raises questions of how certain social identities are privileged and how the lens of intersectionality may be constrained or enabled through research. Further, there is limited insight into the emotional labour and safety for researchers, and how they experience and mitigate vicarious trauma. We examine these issues through a shared critical reflection and conclude with key recommendations to address the challenges and issues identified. Four researchers examining and responding to femicide, family and intimate partner homicide in Australia, Canada and the United Kingdom shared and evaluated their critical reflection. We drew on our experiences and offer insights into processes, impacts and unintended consequences of fatality reviews and research initiatives. There are substantial limitations in accessibility and completeness of data, which has unintended consequences for the construction of social identities of those affected, including how multiple forms of exclusion and structural oppression are represented. Our experiences as researchers are complex and have driven us to implement strategies to mitigate vicarious trauma. We assert that these issues can be addressed by reconceptualizing the goals of data collection and fostering collaborative discussions among those involved in data collection and violence prevention to strengthen research, prevention efforts and safety for all involved.

College Students' Responses to Their Sexually Assaulted Friends: Impact of Rape Myth Acceptance, Prior Victimization, and Social Relationships

College students often confide in their friends following sexual assaults. Friends' reactions may include a variety of emotions and helping behaviors; prior victimization, knowing the accused, and rape myth acceptance may affect these. A sample of 1016 students at a religiously affiliated university completed quantitative surveys measuring their rape myth acceptance, history of sexual assault victimization, disclosures received, and reactions to the most recent disclosure. A subset of 636 students (506 females, 130 males) reported receiving at least one rape disclosure from a friend. Regression analysis of the subset revealed that participants' rape myth acceptance, victimization histories, and relationships to the accused influenced reactions to friends who were sexually assaulted. Students who endorsed rape myths were less likely to lend support to survivors; they were also more likely to experience shame and anger, and to blame their sexually assaulted friends. Students who shared friends with both the survivor and the accused were more likely to offer support to the survivor, experience feelings of divided loyalty, and blame the survivor. Blaming or feeling embarrassed toward survivors was associated with a tendency to advise them on how to avoid revictimization. This suggests that some disclosure recipients focused on their friend's behavior to explain the sexual assault. Cognitive dissonance theory may partially explain the findings.

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.

Identifying compassion satisfaction, burnout, & traumatic stress in Children's Advocacy Centers

BACKGROUND

Little research exists examining burnout related to the multidisciplinary team (MDT) working in a Children's Advocacy Center (CAC) setting.

OBJECTIVES

To measure compassion satisfaction, burnout, and secondary traumatic stress (STS) among CAC MDT professionals; identify work and worker characteristics that may impact compassion satisfaction, burnout, and STS; understand professional and personal impacts of occupational stress; and explore coping responses.

PARTICIPANTS AND SETTING

A cross sectional survey was sent electronically to child abuse professionals working in CAC settings across the United States.

METHODS

Demographics and work characteristics were collected. Participants completed the Professional Quality of Life (ProQOL) to evaluate compassion satisfaction, burnout, and STS and answered open-ended questions regarding professional and personal impacts of occupational stress. Upon completion, participants received their ProQOL scores and additional stress management resources.

RESULTS

A total of 885 participants completed the ProQOL (mean age = 42.07; 85% female). Overall mean scores were average for compassion satisfaction, high average for burnout, and in the top quartile for STS. All three scales differed significantly by MDT professional role (ps < 0.001 to 0.01) and employment length (ps < 0.001 to 0.003). Child welfare workers had significantly higher burnout scores than all other professions except law enforcement and prosecutors and significantly lower compassion satisfaction scores than most others. Professionals providing on-call services had significantly higher burnout (p <  0.001).

CONCLUSIONS

These results contribute to our understanding of MDT professions who might be at higher risk for burnout and STS and help inform future interventions to support the MDT.

Trauma and coping mechanisms exhibited by forensic science practitioners: A literature review

Vicarious trauma (VT) has been studied in mental health experts for over 30 years due to their engagement with victims of trauma and exposure to details of events, crimes, and tragedies experienced by their patients. Recently, VT studies have been extended to first responders as they also engage with victims on a level which may affect their own wellbeing. First responders involved in the criminal justice system, such as law enforcement personnel, have benefited from these studies as the results have helped drive organizational change. However, other professionals throughout the criminal justice system, such as forensic scientists, have had far fewer studies published, and the awareness of VT they may be experiencing has only recently come to light. While this review is not exhaustive of all literature on VT, it showcases key studies and research gaps that could benefit the forensic science community and associated criminal justice system professionals.

Burnout in psychosocial oncology clinicians: A systematic review

OBJECTIVE

Few studies have examined burnout in psychosocial oncology clinicians. The aim of this systematic review was to summarize what is known about the prevalence and severity of burnout in psychosocial clinicians who work in oncology settings and the factors that are believed to contribute or protect against it.

METHOD

Articles on burnout (including compassion fatigue and secondary trauma) in psychosocial oncology clinicians were identified by searching PubMed/MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection.

RESULTS

Thirty-eight articles were reviewed at the full-text level, and of those, nine met study inclusion criteria. All were published between 2004 and 2018 and included data from 678 psychosocial clinicians. Quality assessment revealed relatively low risk of bias and high methodological quality. Study composition and sample size varied greatly, and the majority of clinicians were aged between 40 and 59 years. Across studies, 10 different measures were used to assess burnout, secondary traumatic stress, and compassion fatigue, in addition to factors that might impact burnout, including work engagement, meaning, and moral distress. When compared with other medical professionals, psychosocial oncology clinicians endorsed lower levels of burnout.

SIGNIFICANCE OF RESULTS

This systematic review suggests that psychosocial clinicians are not at increased risk of burnout compared with other health care professionals working in oncology or in mental health. Although the data are quite limited, several factors appear to be associated with less burnout in psychosocial clinicians, including exposure to patient recovery, discussing traumas, less moral distress, and finding meaning in their work. More research using standardized measures of burnout with larger samples of clinicians is needed to examine both prevalence rates and how the experience of burnout changes over time. By virtue of their training, psychosocial clinicians are well placed to support each other and their nursing and medical colleagues.

Minimising trauma in staff at a sexual assault referral centre: What and who is needed?

INTRODUCTION

This study investigates staff's perspectives on the characteristics required to work in a sexual assault referral centre and the support and training they believe sexual assault referral centres should provide to minimise the negative impacts of the work and provide a supportive working environment.

METHODS

Semi- structured interviews were conducted with 12 staff, and a focus group was held with a further four staff of a sexual assault referral centre. The data were examined using thematic analysis.

RESULTS

Findings indicated that to work in a in sexual assault referral centre staff need to be understanding, empathetic, non-judgemental, supportive, flexible and resilient as well as having coping skills. The support structures and processes staff reported as being essential to creating a supportive working environment and reducing vicarious trauma were: supervision; training; peer support and shadowing.

CONCLUSIONS

Working in a SARC is stressful and emotionally difficult work. This study provides valuable insights about the individual and environmental factors SARC staff believe are required to have a happy and healthy workforce delivering a gold standard of care to victim-survivors of sexual violence.

CSEY service provider perceptions of critical needs for effective care as youth transition from juvenile detention to the community

BACKGROUND

The Victims of Trafficking and Prevention Act of 2000 initiated necessary change to treat CSEY as victims rather than criminals. Without sufficient resources, CSEY service providers encounter significant challenges in meeting youth care needs in the community.

OBJECTIVE

This study's purpose was to examine service providers' perceptions of these challenges.

PARTICIPANTS AND SETTING

Semistructured interviews were conducted with nine California CSEY service providers. Thematic analysis principles guided data analysis and interpretation. Key findings indicated needs for improvement of: 1) CSEY screening, 2) relationship building, 3) community resource access, 4) clarity regarding ambiguous feelings and practices associated with the treatment of CSEY as victims or criminals, 5) support systems for service providers experiencing vicarious trauma and acute/chronic stress.

CONCLUSION

Future research is needed to continue to explore the experience of service providers who work with CSEY. Implications for practice include the need for funding to support the development of community-based services for CSEY, particularly for training and professional supports for education, health, social service, and criminal justice professionals.

Reliability and Validity of the Vicarious Trauma Organizational Readiness Guide (VT-ORG)

The Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment of an organization's readiness to address vicarious trauma (VT), which is exposure to the traumatic experiences of people served. This study reports on the psychometric properties of the VT-ORG. Employees of first responder agencies (e.g., law enforcement, fire, emergency services) and victim assistance agencies are at a high risk for vicarious traumatization, which can lead to PTSD, substance use, and suicidal ideation, among other negative impacts. Organizations that do not address VT may see such effects as employee turnover, reduced efficiency, and negative work environments. The VT-ORG is an assessment tool designed to help organizations complete the first step of organizational change-conducting a needs assessment. Study participants were 3,018 employees across 13 first responder and victim assistance agencies who completed the 67-item VT-ORG and additional measures for evaluation of its validity and reliability. The VT-ORG was found to have excellent internal consistency (Cronbach's α = .98). A structural equation model demonstrated that the subscales of the VT-ORG predicted criterion measures of turnover intention, compassion satisfaction, and organizational resilience, with an overall model fit of CFI = .99, RMSEA = .053. This study found the VT-ORG to be a reliable and valid assessment of organizational responses to vicarious trauma.

Secondary distress in violence researchers: a randomised trial of the effectiveness of group debriefings

BACKGROUND

Secondary distress including emotional distress, vicarious trauma (VT) and secondary traumatic stress (STS) due to exposure to primary trauma victims have been described in helping professionals and in violence researchers. To our knowledge, there are few prevalence studies, and no tailored interventions have been tested to reduce secondary distress in violence researchers. The study aims to (1) describe the epidemiology of secondary distress experienced by violence researchers; to (2) assess the effectiveness of group debriefings in mitigating secondary distress; to (3) assess risk and protective factors.

METHODS

We conducted an un-blinded, individually randomised trial with parallel assignment. Eligible participants were 59 Ugandan researchers employed by the Good Schools Study to interview children who experienced violence in a district of Uganda. Fifty-three researchers agreed to participate and were randomly allocated. The intervention group (n = 26) participated in three group debriefings and the control group (n = 27) in three leisure sessions (film viewings). The primary outcome was change in levels of emotional distress (SRQ-20); secondary outcomes were levels of VT and STS at end-line. A paired t-test assessed the difference in mean baseline and end-line emotional distress. Un-paired t-tests compared the change in mean emotional distress (baseline vs. end-line), and compared levels of VT and STS at end-line. Separate logistic regression models tested the association between end-line emotional distress and a-priori risk or protective factors.

RESULTS

Baseline and end-line levels of emotional distress were similar in control (p = 0.47) and intervention (p = 0.59) groups. The superiority of group debriefing over leisure activities in lowering levels of emotional distress in the intervention group (n = 26; difference in SRQ-20 = 0.23 [SD = 2.18]) compared to the control group (n = 26; difference in SRQ-20 = 0.23 [SD = 1.63]) could not be detected (p = 1). In regression analysis (n = 48), baseline distress increased the odds of end-line distress (OR = 16.1, 95%CI 2.82 to 92.7, p = 0.002). Perceived organisational support (OR = 0.09, 95%CI 0.01 to 0.69, p = 0.02) and belief in God (OR = 0.21, 95%CI 0.03 to 1.26, p = 09) was protective against end-line distress.

CONCLUSION

We found no evidence that violence researchers experienced elevated emotional distress after doing violence research. There was no difference between group debriefings and leisure activities in reducing distress in our sample. However, the hypotheses presented should not be ruled out in other violence research settings. Our findings suggest that organisational support is a significant protective factor and belief in God may be an important coping mechanism.

TRIAL REGISTRATION

Clinical Trials NCT02390778 . Retrospectively registered 19 March 2015. The Good Schools Trial was registered at ( NCT01678846 ), on August 24, 2012.

Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents' secondary traumatic stress?

PURPOSE

Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans.

METHODS

We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles.

RESULTS

Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring's experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent's experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %.

CONCLUSIONS

Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.

Caring for Trauma Survivors

Although trauma exposure is common, few people develop acute and chronic psychiatric disorders. Those who develop posttraumatic stress disorder likely have coexisting psychiatric and physical disorders. Psychiatric nurses must be knowledgeable about trauma responses, implement evidence-based approaches to conduct assessments, and create safe environments for patients. Most researchers assert that trauma-focused cognitive-behavioral approaches demonstrate the most efficacious treatment outcomes. Integrated approaches, offer promising treatment options. This article provides an overview of clinical factors necessary to help the trauma survivor begin the process of healing and recovery and attain an optimal level of functioning.

Identifying, Preventing, and Addressing Job Burnout and Vicarious Burnout for Social Work Professionals

Genuineness, concern for others, and empathy are characteristics used to describe the professional social worker. To this end, the social worker tirelessly works on behalf of and in collaboration with the client to move them from stagnant life situations into positive life situations. While the fundamental principles of social work are wonderful, the result for some workers is job burnout and/or vicarious trauma. The concepts of job burnout, its antecedents, and manifestations are thoroughly discussed in this article to provide a holistic overview of this phenomenon. The six antecedents: workload, control, values, fairness, reward, and community are discussed and linked to the manifestations of job burnout. When working with individuals who have been exposed to the depravity of life, the professional can take on the client's vulnerabilities, victimizations, and stress. The common term for this phenomenon is vicarious trauma. Professionals who work with trauma victims can often have issues in their personal and professional life as evidenced by reduced professional efficacy, increased emotional concerns, and physical concerns. The purpose of the author in this article is to provide an overview of job burnout, vicarious trauma, and a discussion about self-care responsibilities.

Psychological Distress of Internal Medicine Residents Rotating on a Hematology and Oncology Ward: An Exploratory Study of Patient Deaths, Personal Stress, and Attributed Meaning

OBJECTIVE

Effectively managing patient distress in oncology is challenging. Trainees in oncology experience distress along with their patients and patients' families, especially during an inpatient admission. This study evaluated the physician-in-training experience while working on an inpatient hematology-oncology ward.

METHODS

We collected a survey from internal medicine interns and residents at the end of a 2- or 4-week-long rotation on a hematology-oncology ward. It included the Impact of Events Scale-Revised (IES-R), a measure of distress, information about resident demography, rotation experiences with death, and personal circumstances that could affect distress levels. House officers were asked to provide comments regarding their most stressful experiences or how they were affected by dying patients.

RESULTS

Fifty-six residents completed questionnaires (58 % overall response rate) and scored IES-R 18.7 (SD 14.2) indicating that the majority (80 %) experienced significant clinical distress (IES-R ≥8) and 20 % experienced posttraumatic stress disorder (PTSD) levels of distress (IES-R ≥33). Comment themes are highlighted and included general frustration and death-related events. Forty-one (73 %) reported that their IESR event was a death-related experience, and 39 (69.6 %) reported that attending to dying patients was the most stressful part of the rotation. Residents cared for 4.28 patients at the end of life on average during the rotation, and 68 % derived a sense of meaning from such work.

CONCLUSIONS

This study suggests that physician-trainee distress is significantly elevated while working on a hematology-oncology ward and may relate to general frustration and death-related events. Further study should evaluate the etiology of medical trainee distress in oncology.

Vicarious memories

People not only have vivid memories of their own personal experiences, but also vicarious memories of events that happened to other people. To compare the phenomenological and functional qualities of personal and vicarious memories, college students described a specific past event that they had recounted to a parent or friend, and also an event that a friend or parent had recounted to them. Although ratings of memory vividness, emotional intensity, visualization, and physical reactions were higher for personal than for vicarious memories, the overall pattern of ratings was similar. Participants' ratings also indicated that vicarious memories serve many of the same life functions as personal memories, although at lower levels of intensity. The findings suggest that current conceptions of autobiographical memory, which focus on past events that happened directly to the self, should be expanded to include detailed mental representations of specific past events that happened to other people.