Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care

INTRODUCTION

With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals.

METHODS

Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews.

RESULTS

Three themes emerged from the four focus groups (N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices.

DISCUSSION

Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.

Transcultural Factors in Hypnotizability Scales: Limits and Prospects

Hypnotic suggestibility--loosely termed hypnotizability--is difficult to assess across cultures. Investigators often use translated research instruments to guide their inquiry in disparate geographic locations. Present-day hypnosis researchers rely heavily on two primary scales that are more than half a century old: the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) (Weitzenhoffer & Hilgard, 1959) and the Harvard Group Scale of Hypnotic Susceptibility: Form A (HGSHS:A) (Shor & Orne, 1962). Scholars typically translate these scales to measure hypnotizability transculturally. This approach, however, operates under the specious assumption that the concept of hypnotizability is largely monolithic or universal across cultures. Whereas translations likely conserve the linguistic content, they may arguably imply different cultural meanings and historical subtexts. Whereas social scientists acknowledge the importance of qualitative and phenomenological accounts in the study of altered consciousness, including suggestibility, researchers interested in hypnotizability consider the impact of findings from anthropology and ethnography too little. Clinicians and scholars of hypnosis would stand to benefit from incorporating the insights afforded by transcultural research in the overarching investigation of a concept as nuanced as hypnotizability.

Comparing the validity of the self reporting questionnaire and the Afghan symptom checklist: dysphoria, aggression, and gender in transcultural assessment of mental health

BACKGROUND

The relative performance of local and international assessment instruments is subject to ongoing discussion in transcultural research on mental health and psychosocial support. We examined the construct and external validity of two instruments, one developed for use in Afghanistan, the other developed by the World Health Organization for use in resource-poor settings.

METHODS

We used data collected on 1003 Afghan adults (500 men, 503 women) randomly sampled at three sites in Afghanistan. We compared the 22-item Afghan Symptom Checklist (ASCL), a culturally-grounded assessment of psychosocial wellbeing, with Pashto and Dari versions of the 20-item Self-Reporting Questionnaire (SRQ-20). We derived subscales using exploratory and confirmatory factor analyses (EFA and CFA) and tested total and subscale scores for external validity with respect to lifetime trauma and household wealth using block model regressions.

RESULTS

EFA suggested a three-factor structure for SRQ-20--somatic complaints, negative affect, and emotional numbing--and a two-factor structure for ASCL--jigar khun (dysphoria) and aggression. Both factor models were supported by CFA in separate subsamples. Women had higher scores for each of the five subscales than men (p < 0.001), and larger bivariate associations with trauma (rs .24 to .29, and .10 to .19, women and men respectively) and household wealth (rs -.27 to -.39, and .05 to -.22, respectively). The three SRQ-20 subscales and the ASCL jigar khun subscale were equally associated with variance in trauma exposures. However, interactions between gender and jigar khun suggested that, relative to SRQ-20, the jigar khun subscale was more strongly associated with household wealth for women; similarly, gender interactions with aggression indicated that the aggression subscale was more strongly associated with trauma and wealth.

CONCLUSIONS

Two central elements of Afghan conceptualizations of mental distress--aggression and the syndrome jigar khun--were captured by the ASCL and not by the SRQ-20. The appropriateness of the culturally-grounded instrument was more salient for women, indicating that the validity of instruments may be gender-differentiated. Transcultural validation processes for tools measuring mental distress need to explicitly take gender into account. Culturally relevant measures are worth developing for long-term psychosocial programming.