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A systematic review of the measurement of compassion fatigue, vicarious trauma and secondary traumatic stress in physicians
Abstract
Compassion fatigue, vicarious traumatisation and secondary traumatic stress, are all terms used to describe the potential emotional impact on health professionals of working with traumatised patients and clients. These terms are often used interchangeably although recent thinking supports some differences. The consequence of experiencing emotional distress as a result of patient contact is not less in physicians than in other health care professionals. However, these constructs have received little attention in the physician work force. This article reports on a systematic review of literature that reported one or more of these three constructs and as well as including attempts to measure them.
... Secondary traumatic stress is a growing concern and there has been a recognizable focus to examine its effects on physicians [1][2][3][4][5][6]. Secondary traumatic stress is a compelling issue because of its potential risks to physicians who provide care to traumatized patients. ...
... Secondary traumatic stress is a compelling issue because of its potential risks to physicians who provide care to traumatized patients. Secondary traumatic stress, secondary trauma, vicarious trauma, second victim, and compassion fatigue are used interchangeably to describe the indirect consequential impact on healthcare professionals who work with traumatized patients, and research shows that the terms are often associated with burnout in physicians [7][8][9][10]3,11,12]. The likelihood of physicians being exposed to secondary traumatic stress is plausible and the effects of burnout may vary depending upon physicians' involvement with traumatized individuals. ...
... Healthcare professionals have a higher rate of exposure to traumatized individuals in their work environments than the general population which could lead to secondary traumatic stress [8,10,[3][4][5]. The work environment in which physicians work may pose increased challenges by traumatic and distressful situations they encounter. ...
The narrative review was important in understanding secondary traumatic stress among physicians. The primary aim of this narrative review was achieved by reviewing qualitative and quantitative studies to analyze if physicians were at-risk of being exposed to secondary traumatic stress when providing care to traumatized individuals. A review of the literature revealed a significant finding that identified 29 medical specialties that were more likely to be exposed to secondary traumatic stress associated with burnout when subjected to repetitive indirect traumatic exposures. An interesting finding showed that physicians were at a greater risk of secondary traumatic stress when they worked longer hours per day (12 hours or more), extended hours throughout the week (80 hours or more), and worked primarily overnight shifts. An unexpected finding in this narrative review revealed that physicians with dependents (e.g., a child/children) had an increased risk of being vulnerable to the effects of secondary traumatic stress. This noteworthy finding was compelling because factors that interlinked dependents to secondary traumatic stress among physicians were unanticipated. Though this narrative review contributes to the body of literature, further studies are necessary because research on secondary traumatic stress among physicians is limited and the lack of literature suggests needed future research.
... Staff who are experiencing compassion fatigue have reduced job satisfaction [21] and reduced efficiency levels resulting in reduced service quality [98]. Patient satisfaction levels are lower in institutions where job satisfaction and burnout levels are reduced [97]. ...
... More staff members experience an intensifying desire to leave their workplace, profession [15, 24,60] and specialty [80]. Compassion fatigue and burnout result in workplace imbalances [24,60] with higher rates of staff turnover [95], and attrition and eventually, workforce dropout [98]. Staff turnover rates are particularly volatile in in high-stakes environments [100] such as oncology and emergency medicine. ...
... Compounding the impact of compassion fatigue is the perception that indicators of a poor working environment, such as increased rates of absenteeism, reduced service quality, low levels of efficiency are being ignored by the organisation and healthcare system [18,98]. Concerns include the conclusion by staff that administrators do not consider caregiver stress when allocating tasks [13]. ...
Evidence is clear regarding the importance of empathy in the development of effective relationships between healthcare professionals (HCPs) and patients in the delivery of successful healthcare. HCPs have pledged to relieve patient suffering, and they value the satisfaction felt from caring for their patients. However, empathy may lead to negative consequences for the empathiser. If there is a personal identification with the emotions of the distressed person, empathic concern may evolve into personal distress leading to compassion fatigue over time. A narrative review was used to explore the connection between empathy and compassion fatigue. A search of MEDLINE, PsychINFO and CINAHL resulted in 141 articles meeting the inclusion criteria. The results included in this chapter explore the practical implications of empathy in relation to compassion fatigue, examining the impact on HCPs as well as the potential risk factors and effective strategies to reduce compassion fatigue. The negative impact of compassion fatigue can have a severe impact on HCP well-being and can in turn impact the care received by the patient. Nevertheless, and despite existing effective strategies to support and manage those experiencing compassion fatigue, more needs to be done to prevent its development in HCPs.
... The diagnosis is also synonymous with CF. After understanding another person's events, one's own behavior and emotion can then also be affected by these events [1,2,4]. Some years later CF was used to explain the challenges faced by healthcare workers, however, there was no definite concept at that time. ...
... In 2002, Figley defined the CF of nurses as the continuous attention and tension to trauma patients, resulting in avoidance, numbness and trauma to the related needs of patients [3]. Many researchers have found that compassion fatigue is common among nurses [4][5][6][7][8]. The existence of compassion fatigue would seriously affect the working state, physical and mental health of nurses [4][5][6][7][8]. ...
... Many researchers have found that compassion fatigue is common among nurses [4][5][6][7][8]. The existence of compassion fatigue would seriously affect the working state, physical and mental health of nurses [4][5][6][7][8]. Through the study of compassion fatigue and its related concepts, which could remind nurses and managers to pay attention to the occurrence of it so as to avoid the related adverse effects. ...
... 4 Health care workers are expected to be compassionate; however, those with a high proportion of traumatic cases or are overly responsive with compassion reactions are at risk of developing compassion fatigue. 5 Health care workers are often impacted by compassion fatigue, 6,7 but little appears in the literature about rehabilitation health care workers' experiences with compassion fatigue. As with all health care workers, health workers providing rehabilitation services must be adequately supported to minimise the risk of compassion fatigue. ...
... Stamm's professional quality-of-life model provides a conceptual basis for examining compassion satisfaction and compassion fatigue. 7,8 The model proposes that compassion satisfaction results from pleasure from undertaking a health care role. In contrast, compassion fatigue is the negative result of health care provisioning to those who have experienced traumatic events and suffering, with compassion fatigue comprising burnout and secondary traumatic stress. ...
... 9 Symptoms from these conditions are likely to result in increased time off work (medical absenteeism), high staff attrition rates, increased likelihood of psychological injury workers' compensation claims, suboptimal patient care and increased errors by health care workers. 7,10 Although compassion fatigue, burnout and secondary traumatic stress are important issues for all health care workers, they may be especially so for health care workers in rural and remote areas where services are not resourced to the extent of those in metropolitan areas. 11 Based on the Australian Bureau of Statistics (ABS) geographical classification system, almost one-third of Australians live in rural and remote locations. ...
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.
... ST, VT, STS, and CF are therefore used interchangeably in the literature (Cieslak et al., 2013;Gołąb et al., 2014) and are referred to and researched as the same thing, as these concepts are not generally considered to be conceptually distinct (Bercier & Maynard, 2015). While this creates some confusion for researchers trying to measure these concepts, there is a general consensus regarding the fact that all of these constructs result from working with traumatized people (Bercier & Maynard;Cieslak et al.;Gołąb et al.;Greinacher et al., 2019;Huggard et al., 2017;Nimmo & Huggard, 2013;Sodeke-Gregson et al., 2013). ...
... While these interrelated concepts of interest (COI) may not be theoretically distinct, when examined individually, they contribute a better understanding of the consequential negative sequelae of caring (Nimmo & Huggard, 2013). Some authors make the argument that CF is comprised of both STS and burnout, so while some overlap exists, there are aspects of CF that are unique (Stamm, 2010). ...
... Despite having no restrictions on publication dates, types of research designs, outcome measures, psychologist characteristics (including discipline, geographical location, or work setting) and the inclusion of four different COI -only eight papers were identified from the selected databases. This supports previous findings from the literature base as systematic reviews on the presence of VT, STS, and CF in physicians (Nimmo & Huggard, 2013) and in alcohol and other drug clinicians (Huggard et al., 2017) also noted the scarcity of available research on these concepts. It appears that research on these concepts has continued to receive little attention by researchers despite the significant negative consequences and impacts associated with them. ...
Secondary trauma, which is also often referred to as secondary traumatic stress, vicarious traumatization, and compassion fatigue are the negative consequences that occur when an individual hears about the traumatic experiences of another person. Certain professions who are exposed to hearing about traumatic experiences are at an increased risk of these difficulties. Psychologists are one such group, and the aim of the current systematic review was to investigate the prevalence of and variables associated with these concepts in psychologists. The following databases were searched as part of the review: PsycINFO, PsycARTICLES, Embase, MEDLINE, and Web of Science. Inclusion criteria required that psychologists were qualified and involved in therapeutic work. Eight articles were extracted for narrative synthesis. The articles indicated that psychologists are not typically meeting the clinical threshold for the various concepts of interest, although a single representative figure could not be determined for this cohort. Potential reasons for this are discussed. An exception to this finding was observed for psychologists working directly with trauma, as difficulties resulting from the concepts of interest were indicated within this cohort. A key finding was the paucity of research that exists on this topic. Limitations and implications of the findings are outlined.
... The introduction of secondary traumatic stress was preceded by the notion of compassion fatigue [3]. It was initially used in relation to nurses and then broadened to therapists and other professionals dealing with the mental accidents-are subject to negative consequences of exposure to trauma [8][9][10][11][12][13]. As underlined by Beck [14], STS is perceived as a professional risk factor among health care professionals. ...
... The studies conducted among paramedic personnel, the majority of which consisted of doctors, in 10 hospitals of one of the States in the USA shows that nearly 13% meet the STS criteria and almost 34% presented at least one symptom included in the scope of each of three STS categories, that is an intrusion, arousal and avoidance [15]. One of the studies mentioned by Nimmo and Huggard [12] shows that more than half (54%) of doctors who participated in the study met the criteria of compassion fatigue or STS. Yet, it results from other studies presented by the authors that the intensity of STS among doctors was low. ...
... It should be underlined that the research conducted worldwide and in Poland confirm the high risk of secondary posttraumatic stress disorders among medical personnel, especially nurses [8,9,[11][12][13]. It is of significance that in the case of medical staff-as opposed to other occupational groups whose members provide help for people who experienced trauma-the indirect exposure often coexists with direct traumatic experiences, including assault and aggression attacks from patients as well as other personal traumatic experiences. ...
Introduction
Medical personnel is an occupational group that is especially prone to secondary traumatic stress. The factors conditioning its occurrence include organizational and work-related factors, as well as personal features and traits. The aim of this study was to determine Secondary Traumatic Stress (STS) indicators in a group of medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma.
Material and methods
Results obtained from 419 medical professionals, paramedics and nurses, were analyzed. The age of study participants ranged from 19 to 65 ( M = 39.60, SD = 11.03). A questionnaire developed for this research including questions about occupational indicators as well as four standard evaluation tools: Secondary Traumatic Stress Inventory, Job Satisfaction Scale, Social Support Scale which measures four support sources (supervisors, coworkers, family, friends) and Cognitive Processing of Trauma Scale which allows to evaluate cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret) were used in the study.
Results
The results showed that the main predictor of STS symptoms in the studied group of medical personnel is job satisfaction. Two cognitive strategies also turned out to be predictors of STS, that is regret (positive relation) and resolution/acceptance (negative relation). The contribution of other analyzed variables, i.e., denial, workload and social support to explaining the dependent variable is rather small.
Conclusions
Paramedics and nurses are at the high risk of indirect traumatic exposure and thus may be more prone to secondary traumatic stress symptoms development. It is important to include the medical personnel in the actions aiming at prevention and reduction of STS symptoms.
... Terminology preferred by some helping professionals, like doctors (Nimmo & Huggard, 2013); some researchers support the notion that CF can be used interchangeably with STS (Figley, 1995); reduced ability to remain empathic to or interested in clients due to emotions and emotional response (Adams, Boscarino, & Figley, 2006); loss of energy, similar in effect to burnout (Stamm, 2010); compassion satisfaction could work as a protective factor (Figley, 2002); Burnout ...
... STS literature can seem to be an inadvertently small sample of traumatology research literature due to the terminology. Another area that needs more consideration has been raised by Nimmo and Huggard (2013), who noted that STS research for physicians is severely limited because most research in this area is completed with the terminology "compassion fatigue" or "vicarious trauma." There may be definition distortion, which would require greater clarity of definitions to parse further the differences between compassion fatigue, vicarious trauma, and secondary stress. ...
... and social work(Ben- Porat & Itzhaky, 2011;Bride et al., 2004;Tosone, McTighe, Bauwens, & Naturale, 2011). STS research also includes the medical fields like doctors and nurses in hospital settings(Granek et al., 2017;Markwell & Wainer, 2009;Morrison & Joy, 2016;Nimmo & Huggard, 2013;Townsend & Campbell, 2009), disaster response (McLennan, Evans, Cowlishaw, Pamment, & Wright, 2016), and even 9-1-1 emergency response(Pierce & Lilly, 2012). STS research now includes refugee resettlement (Akinsulure-Smith, Espinosa, Chu, & Hallock, 2018), firefighting(Lee, Lee, Kim, Jeon, & Sim, 2017), ancillary veteran work(Bachem et al., 2018;Yager, Gerszberg, & Dohrenwend, 2016), religious work ...
People who support others who have experienced trauma, like nurses, doctors, social workers, or first responders can sometimes be affected by a type of stress called secondary traumatic stress (STS). Although the effect of STS has been studied in helpers like social workers and medical professionals, the prevalence and characteristics of STS in teachers have not been studied extensively and are less understood. Schools in our communities impacted by the opioid epidemic also report additional stressors from issues like addiction, overdose, crime, neglect, rise in foster care, increased medical care, and death. This dissertation investigates STS in K-12 public school teachers in the United States, in areas of varying opioid impact. Specifically, K-12 teachers (n = 450), in 26 states and Washington, D. C., were surveyed utilizing a validated instrument for secondary traumatic stress (Secondary Traumatic Stress Scale; Bride, Robinson, Yegidis, & Figley, 2004), along with demographic questions and open-ended questions. Teachers were also asked about adverse childhood experiences of their students, using the PHL-ACE categories (Health Federation of Philadelphia and Philadelphia ACE Research and Data Committee, 2012). The prevalence and extent of teacher STS were explored in communities of low-, medium-, and high-opioid impact levels as defined by the National Institute of Health epidemiology parameters. I used descriptive statistics and correlations (Spearman’s Rho) to determine the prevalence of STS in the sample of teachers and to determine if this prevalence had any relationship to the opioid mortality rate in communities. Over half of the teachers in the VII study (59.56%) experienced STS at a moderate or higher level. Teachers in high opioid zones reported the highest mean STSS scores (M = 43.78, SD = 16.00), with 62.67% scoring at 38 or higher. Over 85% of teachers endorsed intrusion symptoms at a diagnostic level. Between 91-93% of all teachers surveyed endorsed adverse events experienced by their students. Using Spearman’s Rho correlation, I did not find a relationship between the environment of the opioid zone or the demographic characteristics of the teachers. Additional findings and implications are discussed and support the need to continue teacher STS research in all communities.
... As mentioned above, it is common among PCPs [6] and may result in low job satisfaction and powerlessness and can adversely influence quality of care, increase the risk for medical errors, and promote early retirement. Compassion fatigue refers to diminished capacity of a health professional when he/she experiences repeated distress at knowing about or witnessing the suffering of patients; it is often the result of helping and knowing about trauma [90,92]. ...
... Burnout and compassion fatigue are common among healthcare personnel and are not unique to those who work with survivors of trauma. Conversely, vicarious traumatization is unique to those who work with trauma-exposed patients and occurs when a clinician experiences negative transformative processes [92], a change in their inner experience, or a system of meaning, as a result of engagement with survivors; at times, it can be as debilitating as the primary trauma [90]. Vicarious traumatization can afflict the entire care team, including administrative staff [90]. ...
... Vicarious traumatization can afflict the entire care team, including administrative staff [90]. Higher risk of vicarious traumatization is conferred by personal trauma history, chronicity of trauma work, combining service provision and research, younger age of the clinician, and the individual's capacity for empathy [90,92]. Most of the literature on vicarious traumatization focuses on mental health providers, social workers, first responders, and humanitarian workers, although work on primary care providers and health professions trainees is emerging [92,96]. ...
This chapter will address trauma-informed care in adult primary care settings. While a substantial body of literature exists on implementing trauma-informed care in mental health and pediatric settings, less has been written about best practices and strategies for adult primary care settings. In the United States, primary care providers manage adults with chronic pain, substance use, and comorbid mental health conditions. Patients with these conditions have a high prevalence of trauma exposure, which adversely impacts their health and complicates their care. While collaborative care, or integrated behavioral health care, is becoming more widespread, many primary care providers manage these challenging patients alone without access to adequate mental health support. Despite the prevalence of trauma and the comorbidity and complexity of adult primary care patients visit length is often short, and providers frequently carry large panels of patients. High levels of burnout have been reported among PCPs, and access to primary care is poor in many parts of the country. Trauma-informed care approaches hold promise for improving patient care and mitigating some of the challenges commonly experienced by both patients and clinicians.
... The concept of secondary trauma has been widely studied over the last 30 years and can be considered as exposure to trauma through the first-hand account or narrative of a traumatic event by another (Cieslak et al., 2014;Figley, 1995), and has been described as an occupational hazard of working in a caring profession (McCann and Pearlman, 1990;Nimmo and Huggard, 2013). In extreme cases this subsequent cognitive or emotional representation of an event may result in symptoms and reactions that parallel PTSD, such as re-experiencing, avoidance and hyperarousal (Cieslak et al., 2014;Figley, 1995). ...
... The impact of secondary trauma has been studied within a number of professions such as social/child protection workers (Bride, 2007;Conrad and Kellar-Guenther, 2006), therapists and counsellors (Baird and Jenkins, 2003;Craig and Sprang, 2010;Kadambi and Truscott, 2007;Pearlman and Mac Ian, 1995;Sodeke-Gregson et al., 2013) and medical professionals (Duffy et al., 2015;Kellogg et al., 2018;Regehr et al., 2003), yet few studies relate to policing, or particularly policing within the United Kingdom (UK). There are a number of key concepts that relate to secondary trauma which are frequently used interchangeably (Bober and Regehr, 2006;Newell and MacNeil, 2010;Nimmo and Huggard, 2013;Sabin-Farrell and Turpin, 2003) such as Burn-out (Freudenberger, 1974(Freudenberger, , 1975Maslach 1976), Vicarious Trauma (McCann andPearlman, 1990), Compassion Fatigue (Joinson, 1992) and Secondary Traumatic Stress (Figley, 1995). ...
A systematised literature review examining existing research relating to secondary trauma and Post-Traumatic Stress Disorder (PTSD) within UK police officers. The review identified 20 studies in police officers from Scotland, England, Wales and Northern Ireland. These studies comprised of terrorist incidents, mass disasters, general policing duties and officers working in rape and child abuse investigations. Key themes emerged regarding understanding the impact of trauma, the influence of police culture and understanding coping mechanisms.
... "The physician who treats himself has a fool for a patient." -Sir William Osler, physician, (1849-1919) The studies and literature available suggests that medical doctors are greatly affected by professional and personal distress and that high rates of BO, depression, and suicide are often found and that they deteriorate the professional and personal quality of life of medical doctors Nimmo & Huggard, 2013). ProQOL consists of BO, STS, and CS. ...
... The literature demonstrates that persistent exposure to a high level of occupational distress contributes to vulnerability and the development of neurological and psychiatric disorders. Fatigue and exposure to secondary trauma lead to increases in anxiety, fear, depression, and medically unexplained pain, and, in extreme cases, to serious thoughts of self-harm and suicide attempts (Harvey, Laird, Henderson, & Hotopf, 2009;Nimmo & Huggard, 2013;Silverman, 2000). The perception of the general populations in every context and culture is that the job of a medical doctor is a prestigious one offering financial security, social rewards, and high pay. ...
Background: This research studied the prevalence of professional and personal distress of Nepali doctors, a previously unexplored subject, and examined the impact of their professional quality of life (ProQOL) on their distress.
Aim: To examine the existing situation of personal and professional distress and explore interrelationships between measures of ProQOL (burnout - BO, secondary traumatic stress - STS, and compassion satisfaction - CS) with personal distress (anxiety, depression and somatic burden) of Nepali doctors.
Methods: A non-experimental survey design was used to examine the personal and professional distress of doctors using an online and a paper-and-pencil survey with the use of SSS-8, HSCL-25, and ProQOL5-N measurement tools. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques were used to measure the influence of professional distress on personal distress.
Results: The prevalence of anxiety, depression, psychosomatic distress, and suicide risks of Nepali doctors (N= 557) were 30.89 %, 25.41 %, 20.5%, and 5.7 % respectively. BO and STS scores showed moderate risk, with just over 1% of doctors at high risk for BO and STS. The doctors were highly satisfied with their service. Distress measurement tools, SSS-8, and HSCL-25, and ProQOL-5, all in the Nepali language, were tested through CFA. The data on SEM showed a reasonably good fit between the STS and CS measures of doctors and their levels of personal distress, but BO could not be tested. A moderate but statistically significant positive effect of STS on personal distress, except psychosomatic distress, was found. Nevertheless, the effect of CS on personal distress could not be determined.
Conclusions: One-fifth of Nepali doctors had a high level of personal distress. The risk for BO and STS was moderate. Nepali doctors found highly satisfied with the service they offer. The impact of professional distress on personal distress could not be fully determined. Nepali versions of SSS-8 and HSCL-25 were tested and verified for future use; however, ProQOL measures, mainly BO, require further studies.
Keywords: Depression, Suicide, Burnout, ProQOL, SEM, Nepali Doctors
Citation: Adhikari, Y. (2020). Prevalence of Professional Quality of Life (ProQOL) and Its Influence on the Personal Distress of Doctors in Nepal. (Doctor of Philosophy Dissertation, University of Nicosia).
... Compassion fatigue is described as a healthcare practitioner's diminished capacity to care as a consequence of repeated exposure to the suffering of patients, and from the knowledge of their patient's traumatic experiences. 1 Compassion fatigue is a result of providing patient care, and is more often considered as the result of many events, though it could arise from the experience of caring for an individual patient or event. Compassion fatigue is closely related to the concepts of "vicarious trauma" and "secondary traumatic stress (STS)," both of which also result from exposure to the trauma experienced by patients, rather than to the trauma itself. 2 However, other factors contribute to the development of compassion fatigue, for example, burnout (BO) may develop through factors such as work hours (i.e. ...
... Although BO and other distress may affect providers, compassion fatigue may more severely affects patients as it is the direct effect of a healthcare provider's diminished capacity to care that results from repeated exposure to the suffering of their patients, as well as from the knowledge of their patient's traumatic experiences. 1 Nimmo and Huggard, 1 in a review of compassion fatigue in physicians, report that issues are "often reflected in outcomes of emotional distress, pain, and suffering, and may manifest in increased rates of absenteeism, reduced service quality, low levels of efficiency, and high attrition rates and eventually, workforce dropout." This evidence of compassion fatigue and the effect on providers and patient care raises an important question on what strategies and programs health systems should consider to prevent or mitigate its effect. ...
Background:
Compassion fatigue is recognized as impacting the health and effectiveness of healthcare providers, and consequently, patient care. Compassion fatigue is distinct from "burnout." Reliable measurement tools, such as the Professional Quality of Life scale, have been developed to measure the prevalence, and predict risk of compassion fatigue. This study reviews the prevalence of compassion fatigue among healthcare practitioners, and relationships to demographic variables.
Methods:
A systematic review was conducted using key words in MEDLINE, PubMed, and Ovid databases. Data were extracted from a total of 71 articles meeting inclusion criteria, from studies measuring compassion fatigue in healthcare providers using a validated instrument. Quantitative and qualitative data were extracted and compiled by three independent reviewers into an evidence table that included basic study characteristics, study strength and quality determination, measurements of compassion fatigue, and general findings. Meta-analysis, where data allowed, was stratified by Professional Quality of Life version, heterogeneity was quantified, and pooled means were reported with 95% confidence interval. A table of major study characteristics and results was created.
Ethical consideration:
This paper contains no primary data obtained directly from research participants. Data obtained from previously published resources have been acknowledged within references. Psychological distress, particularly compassion fatigue, can be insidious, no health profession is immune, and may significantly impact the ability to provide care.
Results:
A total of 71 studies were included. Compassion fatigue was reported across all practitioner groups studied. Relationships to most demographic variables such as years of experience and specialty were either not statistically significant or unclear. Variability in reporting of Professional Quality of Life results was found.
Interpretation:
Compassion fatigue exists across diverse practitioner groups. Prevalence is highly variable, and its relationship with demographic, personal, and/or professional variables is inconsistent. Questions are raised about how to mitigate compassion fatigue.
... The aim of this review was to examine the evidence about the effects of occupational exposure to suffering in psychologists by integrating empirical research on VT, STS, and CF. Although previous reviews have been conducted (e.g., Baum, 2016;Baum & Moyal, 2020;Beck, 2011;Nimmo & Huggard, 2013), to our knowledge, this is the first quantitative synthesis that has intended to address this issue among this discipline. For this aim, 52 articles with 10,233 professionals from different settings (i.e., educational, clinical, military, and NGOs) were included. ...
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.
... The DSM criterion for traumatic stressors, i.e., exposure to aversive elements of traumatic events in the course of work, may indicate that PTSD and STSD are the same phenomenon (Greinacher et al., 2019). Nevertheless, most researchers point out the need to distinguish between these two constructs (McCann and Pearlman, 1990;Figley, 1995Figley, , 1999Crumpei and Dafinoiu, 2012;Nimmo and Huggard, 2013;Michael et al., 2016;Missouridou, 2017;Greinacher et al., 2019). It is worth noting that negative outcomes of secondary exposure to trauma may also be described as Compassion Fatigue (CF) or Vicarious Traumatization (VT) (McCann and Pearlman, 1990;Figley, 1995Figley, , 1999. ...
Introduction: As an occupational group, medical providers working with victims of trauma are prone to negative consequences of their work, particularly secondary traumatic stress (STS) symptoms. Various factors affect susceptibility to STS, including work-related and organizational determinants, as well as individual differences. The aim of the study was to establish the mediating role of cognitive trauma processing in the relationship between job satisfaction and STS symptoms among medical providers.
Procedure and Participants: Results were obtained from 419 healthcare providers working with victims of trauma (218 nurses and 201 paramedics). Three questionnaires, namely the Secondary Traumatic Stress Inventory, Work Satisfaction Scale, and Cognitive Trauma Processing Scale, were used in the study, as well as a survey developed for this research. Correlational and mediation analyses were applied to assess relations between variables.
Results: The results showed significant links between STS symptoms and both job satisfaction and cognitive processing of trauma. Three cognitive coping strategies play the intermediary role in the relationship between job satisfaction and symptoms of secondary traumatic stress. However, this role varies depending on preferred strategies.
Conclusion: Nurses and paramedics are significantly exposed to the occurrence of STS. Thus, it is important to engage health care providers in activities aimed at preventing and reducing symptoms of STS.
... There can be stressful disagreements among staff, for example nurses may disagree with physicians' continuing treatment, because of their closer experience with patient suffering (Puntillo & McAdam, 2006). All clinicians in the ICU are at risk for psychological complications that have been described in overlapping concepts of vicarious or secondary trauma and PTSD, moral injury, compassion fatigue or burnout (as detailed in Nimmo and Huggard, 2013;Van Mol et al., 2015). these terms are used, sometimes interchangeably, to address the loss of compassion or numbing/ distancing providers may experience as a direct result of the work they do (Van Mol, Kompanje, Benoit, Bakker, & Nijkamp, 2015). ...
In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized.
... However, multiple studies have used secondary traumatic stress and compassion fatigue interchangeably and have investigated the association between compassion fatigue and burnout in emergency department nurses [15] and trauma nurses [16]. Meanwhile, some researchers have comprehensively analyzed past studies and attempted to distinguish compassion fatigue from secondary traumatic stress [17]. One such study pointed out the limitations of viewing compassion fatigue as a milder expression of secondary traumatic stress [18], and another criticized studies that equate compassion fatigue to secondary traumatic stress [19]. ...
Due to the nature of their work, trauma nurses are exposed to traumatic situations and often experience burnout. We conducted a cross-sectional study examining compassion satisfaction, secondary traumatic stress, and burnout among trauma nurses to identify the predictors of burnout. Data were collected from 219 nurses in four trauma centers in South Korea from July to August 2019. We used the Traumatic Events Inventory to measure nurses’ traumatic experience and three Professional Quality of Life subscales to measure compassion satisfaction, secondary traumatic stress, and burnout. Multiple regression analysis confirmed that compassion satisfaction and secondary traumatic stress significantly predicted nurses’ burnout, with compassion satisfaction being the most potent predictor. The regression model explained 59.2% of the variance. Nurses with high job satisfaction, high compassion satisfaction, and low secondary traumatic stress tend to experience less burnout than their counterparts. Nurse managers should recognize that strategies to enhance job and compassion satisfaction and decrease secondary traumatic stress are required to decrease burnout among nurses in trauma centers.
... Physicians are at elevated risk of burnout [1], anxiety [2], depression [3], substance abuse [4], and suicide [5] relative to other professionals and to the general population, and poor mental health among physicians may negatively impact the quality of patient care [6]. Sources of on-the-job stress among physicians include the chronic hassle of interacting with electronic health records or EHRs [7] and other online tasks, time constraints and lack of schedule control [8], dealing with dissatisfied and difficult patients [9], threat of malpractice [10], secondary traumatic stress [11], and working in isolation without social support [12]. This study explores how problems with EHRs may detract from physician wellbeing by exacerbating other on-the-job stressors. ...
Background
This study assessed direct and indirect associations between problems with electronic health records (EHRs) and physician distress via problems encountered during the day-to-day practice of medicine and access to social support.Methods
One-hundred and ninety physicians in the state of Nevada completed an online survey in spring of 2019 regarding problems with EHRs, their medical practice, social support, and mental health. A parallel mediator model was tested with 10,000 bias-corrected bootstrap samples to assess associations between EHRs and distress directly and indirectly via medical practice problems and social support.ResultsFrequency of EHR problems was positively associated with problems with the day-to-day practice of medicine, and negatively associated with access to social support. Medical practice problems were positively associated with physician distress, and social support was negatively associated with it. Mediation analyses suggest that EHR problems indirectly affect physician distress via problems encountered during the practice of medicine and social support.Conclusions
Physician wellbeing is a critical priority for health care. This study suggests that reducing EHR problems may improve physician well-being directly and indirectly by addressing problems in the practice of medicine that compound mental health effects of EHRs. Suggestions for improving the integration of EHRs into medical practice are discussed.
... Additionally, they reported that the burnout levels of doctors whose working conditions were poor were higher, and their compassion-satisfaction scores lower, than those of their colleagues with better working conditions. Some reviews of this topic have also been conducted (Ledoux, 2015;Nimmo & Huggard, 2013;Rauvola et al., 2019;Sorenson et al., 2016). ...
Obstetricians and gynecologists are likely to be at risk of occupational distress because their quality of life is affected as a result of their experiences of assisting with traumatic births and/or providing abortions, among others. Nevertheless, there have been few studies of this group of doctors' compassion fatigue. This study aimed to examine obstetricians and gynecologists' compassion fatigue. This survey-based quantitative study examined 107 obstetricians and gynecologists' compassion fatigue. Data were collected using a demographic information form and the Compassion Fatigue Short Scale. This established that had low levels of compassion fatigue related to secondary trauma and job burnout, but moderate levels of it overall. Among female obstetricians and gynecologists, compassion fatigue was higher than among their male counterparts, and respondents who worked at private hospitals had higher compassion fatigue related to secondary trauma than those who worked in state-run hospitals. The data also revealed that obstetricians and gynecologists with 11-15 years' seniority scored higher on the job-burnout subdimension of compassion fatigue, and overall, than their more senior counterparts. Interestingly, however, no statistically significant differences in the participants' compassion fatigue were found to be associated with their ages, marital statuses, numbers of children, number of patients seen per day, or number of daily operations performed. Professional sharing groups that allow doctors to share their experiences and to gain awareness about their colleagues' traumas should be organized. Teamwork should also be encouraged ; and various prevention strategies should also be considered.
... EMS personnel in this study were 48% more likely to have CF when they knew a fellow EMS professional who had completed suicide. This is concerning given the literature on suicide point-clusters-a term often described as suicide contagion-which are institutionally related and describe the increase in suicidality after exposure to suicide in a particular population [6,[45][46][47][48][49][50]. ...
Introduction
Compassion fatigue (CF) is defined as the acute or gradual loss of benevolence that occurs after exposure to critical incident stress. Colloquially referred to as the “cost of caring,” CF can affect an individual’s future response to stressful situations and is unhealthy for caregivers.
Objective
To identify the prevalence and predictors of CF in EMS professionals.
Methods
This was a cross-sectional survey of EMS personnel using one-stage area sampling. Nine EMS agencies recruited based on location and geographic region provided data on service area and call mix. Respondents were surveyed in-person during monthly training. The survey evaluated the relationship between CF and psychosocial factors using the Professional Quality of Life Scale (ProQOL). Parametric and non-parametric tests were used where appropriate for the univariate analysis. Those factors significant in the univariate analysis were included in the multivariable analysis. A logistic regression was conducted to determine predictors of CF while controlling for potential confounders.
Results
A total of 686 EMS personnel completed the survey. Altogether, 48% had CF, of which 50.8% were male and 14% were minorities. Compared to those without CF, more than 4 times as many respondents with CF (n = 28[8.6%] v. 7[2.0%]) self-reported as currently in counseling and over a third (n = 109[33.1%]) had considered suicide. Irrespective of the presence of CF, one in two knew another EMS professional who had completed suicide. African-American EMS professionals were 3 times more likely to have CF (OR:3.1;p = 0.009). Mean scores on the ProQOL CF subscale were 10 points higher in those with CF compared to those without (27.1[±4.34] v. 17.04[±2.9]). EMS personnel were 48% more likely to have CF if they knew an EMS provider who completed suicide (p = 0.047). Additionally, those with concomitant traumatic stress syndromes, such as vicarious trauma and burnout, were 4.61 and 3.35 times more likely to have CF, respectively.
Conclusions
CF is a considerable concern for EMS professionals and there are several modifiable factors that may reduce the prevalence of this cumulative stress syndrome. Additional research should focus on causal factors and mitigation strategies, as well as the individual and agency impact of CF on the prehospital work environment.
... This fatigue is often experienced as a range of psychosocial and physical health issues, including healthcare workers distancing themselves from patients and colleagues, and having feelings of powerless, cynicism, and reduced work satisfaction (Kharatzadeh, Alavi, Mohammadi, Visentin, & Cleary, 2020). (e.g., sexual abuse therapy or HIV/AIDS treatment) were found by Nimmo and Huggard (2013) to be at greater risk. Results from studies vary considerably in prevalence, geographic location, healthcare specialty, and significance, yet they build an overall picture of alarmingly high rates of burnout in the healthcare sector. ...
... Some participants in the study had thought about changing workplace or leaving the profession and some had left the profession. Similarly, Nimmo and Huggard 66 have found that compassion fatigue can lead to workforce dropout. Peters 57 has found that compassion fatigue leads to doubts about one's own values and thoughts about leaving the profession. ...
Background: Nurses that are constantly being exposed to patients' suffering can lead to compassion fatigue. There is a gap in the latest research regarding nurses’ experiences of compassion fatigue. Little is known about how compassion fatigue affects the nurse as a person, and indications of how it affects the profession are scarce.
Aim: The aim of this study was to explore compassion fatigue experienced by nurses and how it affects them as persons and professionals.
Research design, participants, and research context: A qualitative explorative approach was used. The data consisted of texts from interviews with seven nurses in various nursing contexts. Content analysis was used.
Ethical considerations: Ethical approval was sought and granted from an ethical committee at the university were the researchers were based and written, informed consent was obtained from all the participants.
Findings: Five themes were discovered: Compassion as an empathic gift and compassion fatigue as a result of compassion overload, Compassion fatigue as exhausting the nurse as a professional and private person, Compassion fatigue as a crisis with potentially valuable insights, Compassion fatigue can be handled by selfcare and focus on self, Compassion fatigue is affected by life itself and multifaceted factors.
Discussion: Compassion stress and overload can lead to compassion fatigue. Compassion fatigue affects the nurse’s ability to compassion and the caring is no longer experienced in the same way; the nurses experienced it as being deprived of the gift of compassion. Compassion fatigue implicates a crisis with potentially valuable insights.
Conclusion: Compassion fatigue can be symbolized as bruises in the soul, hurtful but with time it can fade away, although it leaves a sense of caution within the nurse, which can affect the suffering patient.
Keywords: compassion fatigue, nurses, experiences, interviews
... Job-related traumatic stress is another outcome that belongs to the occupational context, albeit not to all professions. Defined as stress resulting particularly from indirect exposure to aversive details of traumatic events via face-to-face contact with traumatized individuals or exposure to drastic materials [52], it has been widely recognized as a significant occupational burden among health professionals that needs addressing [53,54]. ...
Background
Medical professionals are exposed to multiple and often excessive demands in their work environment. Low-intensity internet interventions allow them to benefit from psychological support even when institutional help is not available. Focusing on enhancing psychological resources—self-efficacy and perceived social support—makes an intervention relevant for various occupations within the medical profession. Previously, these resources were found to operate both individually or sequentially with self-efficacy either preceding social support (cultivation process) or following it (enabling process).
Objective
The objective of this randomized controlled trial is to compare the efficacy of 4 variants of Med-Stress, a self-guided internet intervention that aims to improve the multifaceted well-being of medical professionals.
Methods
This study was conducted before the COVID-19 pandemic. Participants (N=1240) were recruited mainly via media campaigns and social media targeted ads. They were assigned to 1 of the following 4 groups: experimental condition reflecting the cultivation process, experimental condition reflecting the enabling process, active comparator enhancing only self-efficacy, and active comparator enhancing only perceived social support. Outcomes included 5 facets of well-being: job stress, job burnout, work engagement, depression, and job-related traumatic stress. Measurements were taken on the web at baseline (time 1), immediately after intervention (time 2), and at a 6-month follow-up (time 3). To analyze the data, linear mixed effects models were used on the intention-to-treat sample. The trial was partially blinded as the information about the duration of the trial, which was different for experimental and control conditions, was public.
Results
At time 2, job stress was lower in the condition reflecting the cultivation process than in the one enhancing social support only (d=−0.21), and at time 3, participants in that experimental condition reported the lowest job stress when compared with all 3 remaining study groups (ds between −0.24 and −0.41). For job-related traumatic stress, we found a significant difference between study groups only at time 3: stress was lower in the experimental condition in which self-efficacy was enhanced first than in the active comparator enhancing solely social support (d=−0.24). The same result was found for work engagement (d=−0.20), which means that it was lower in exactly the same condition that was found beneficial for stress relief. There were no differences between study conditions for burnout and depression neither at time 2 nor at time 3. There was a high dropout in the study (1023/1240, 82.50% at posttest), reflecting the pragmatic nature of this trial.
Conclusions
The Med-Stress internet intervention improves some components of well-being—most notably job stress—when activities are completed in a specific sequence. The decrease in work engagement could support the notion of dark side of this phenomenon, but further research is needed.
Trial Registration
ClinicalTrials.gov NCT03475290; https://clinicaltrials.gov/ct2/show/NCT03475290
International Registered Report Identifier (IRRID)
RR2-10.1186/s13063-019-3401-9
... Compassion fatigue refers to the stress that occurs from helping or desiring to help traumatized people (Figley, 1995). Helping professionals with compassion fatigue experience a diminished capacity to care for others as a consequence of the direct exposure to their clients' suffering and knowledge of their traumatic experiences (Nimmo & Huggard, 2013). In many ways, the nature of the counseling profession places those who engage in this vocation at greater risk of experiencing compassion fatigue (Thompson et al., 2014). ...
The present study used a national sample of professional counselors (N = 161) providing services during the COVID-19 pandemic to examine the extent to which perceived stress, coping response, resilience, and post-traumatic stress predict burnout, secondary traumatic stress, and compassion satisfaction. The results of a multiple regression analysis indicated resilience had a strong positive relationship with compassion fatigue and a strong negative relationship to burnout. Perceived stress was also strongly positively related to burnout. Implications and strategies for counselors to mitigate the effects of perceived stress during the COVID-19 pandemic by engaging in self-care practices and cultivating resilience are provided.
... This may manifest as compassion fatigue (Figley, 1995) which is a form of constant worry about patient and is defined as a normal reaction when working with a highly stressed patients. However cumulative compassion fatigue may result in a state of exhaustion and the reduced capacity of the practioner to help the patient after being exposed to their distress (Huggard and Unit, 2013). ...
... Both ProQOL and the STAI have been validated and widely tested in healthcare contexts (Galiana et al., 2017;Nimmo and Huggard, 2013;Herrero Sanz et al., 2012;Smart et al., 2014). ...
Purpose: To assess the prevalence of Compassion Satisfaction, Compassion Fatigue (Burnout and Secondary Traumatic Stress) and anxiety in oncology nurses and the association with demographics, training, work-related conditions, and psychological factors.
Method: A multicentre, cross-sectional study in 8 selected hospitals in Catalonia (Spain) involving oncology nurses. Primary outcomes were Compassion Satisfaction and Compassion Fatigue (Burnout/Secondary Traumatic Stress), evaluated with the Professional Quality of Life questionnaire v.IV, and anxiety, evaluated with the State-Trait Anxiety Inventory.
Results: Of 297 participants, 18.2% (95% confidence interval [CI]:16.1-20.3) presented low Compassion Satisfaction; 20.2% (95% CI:18.0-22.4), high burnout; and 37.4% (95% CI:34.8-40.0), high Secondary Traumatic Stress. Trait and State Anxiety were high in 5.4% (95% CI:4.2-6.6) and 8.1% (95% CI:6.6-9.6) of participants, respectively. Nurses' desire to leave the unit was associated with high burnout (adjusted odds ratio [ORa] 3.7, 95% CI:1.9-7.5) and Secondary Traumatic Stress (ORa 3.2, 95% CI:1.9-5.3), while the desire to leave the profession was related to high State Anxiety (ORa 12.5, 95% CI:4.6-33.7). Most participants (96.9%) were interested in receiving emotional management training.
Conclusions: Continuous demands on oncology nurses' empathy can lead them to experience compassion fatigue, anxiety and a desire to leave the profession. The first study carried out with Spanish oncology nurses shows Compassion Fatigue is highly prevalent. This is related to nurses' desire to change units, leave their profession and has negative implications on staff satisfaction and quality of care. This problem justifies institutions support strategies for these professionals.
... There are related tools that identify symptoms of secondary trauma, like the Secondary Traumatic Stress Scale (STSS) (Bride et al. 2007). A more thorough review of existing CF measures can be found elsewhere (Bride et al. 2007;Nimmo & Huggard 2013). The majority of instruments are designed to measure individual-level CF resulting only from occupational exposure. ...
Non-fatal and fatal overdoses are traumatic events that have been increasing over the past 20 years and disproportionately impacting rural communities in the United States. The human suffering caused by the opioid epidemic is rarely described in the empirical literature. The purpose of this article is to 1) define individual- and community-level overdose-related compassion fatigue (OCF), 2) review measurement of compassion fatigue (CF) and interventions to reduce CF, 3) discuss strategies that may reduce OCF and 4) briefly discuss policy implications. OCF is distress resulting from knowledge of or exposure to overdose-related harms, which at the community-level may prohibit collaboration and adaptive agency to effectively respond. When OCF occurs at a community-level, it could have negative consequences by eroding support for evidence-based services and fueling stigma-driven policies that blame people who use drugs. Empathy underlies both OCF and vicarious resilience by allowing one to understand the suffering caused by overdose deaths and to witness the joy of addiction recovery. Using the risk environment framework, OCF at the micro- and macro-levels of the social environment, may increase rural communities’ vulnerability to harm by emphasizing individual responsibility for reducing overdoses rather than community-level infrastructure and resource management. Additional research is needed to develop a measure of OCF and to confirm whether OCF is associated with increased stigma and decreased support for harm reduction in rural areas.
... The four most commonly recognised conditions associated with working with traumatised victims are burnout, vicarious trauma, compassion fatigue and secondary traumatic stress. These terms have to some degree become interchangeable (Nimmo and Huggard, 2013;Perez et al., 2010;Shoji et al., 2015) and relate to what Figley (1995) described as the 'cost of caring', which he depicted as how an individual may absorb the emotional distress of the primary trauma survivor, and experience symptoms of a similar nature as a result of caring. ...
This article looks at secondary trauma of police officers caused by working with traumatised victims, examining what is the true ‘cost of caring’ for police officers in England and Wales. It will discuss common work-related ‘stressors’ in policing and review the concepts commonly associated with secondary trauma such as ‘burnout’, ‘vicarious trauma’, ‘compassion fatigue’, ‘secondary traumatic stress’ and their impact. It will conclude with some recommendations and highlight the serious lack of literature on this topic, making secondary trauma and post-traumatic stress disorder in policing an under researched area, particularly in relation to the effects of cumulative trauma in policing.
... Burnout (BO) has been described as a combination of emotional exhaustion, depersonalization, and personal accomplishment [5]. Compassion fatigue (CF) is a state of physical or psychological distress, consequent to an ongoing process in a demanding relationship with needy individuals [6,7]. CF is composed of secondary traumatic stress (STS), secondary exposure to people who have experienced extremely or traumatically stressful events [8], and compassion satisfaction (CS), which determines the positive effects from the professional role of helper, resulting in work satisfaction and wellbeing [9]. ...
Objective
Aim of the research was to define the quality of life of Italian neurologists and nurses’ professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue.Material and methodsOne hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis.ResultsMost of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life.Conclusion
The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.
... Both ProQOL and the STAI have been validated and widely tested in healthcare contexts (Galiana et al., 2017;Nimmo and Huggard, 2013;Herrero Sanz et al., 2012;Smart et al., 2014). ...
Purpose:
To assess the prevalence of Compassion Satisfaction, Compassion Fatigue (Burnout and Secondary Traumatic Stress) and anxiety in oncology nurses and the association with demographics, training, work-related conditions, and psychological factors.
Method:
A multicentre, cross-sectional study in 8 selected hospitals in Catalonia (Spain) involving oncology nurses. Primary outcomes were Compassion Satisfaction and Compassion Fatigue (Burnout/Secondary Traumatic Stress), evaluated with the Professional Quality of Life questionnaire v.IV, and anxiety, evaluated with the State-Trait Anxiety Inventory.
Results:
Of 297 participants, 18.2% (95% confidence interval [CI]:16.1-20.3) presented low Compassion Satisfaction; 20.2% (95% CI:18.0-22.4), high burnout; and 37.4% (95% CI:34.8-40.0), high Secondary Traumatic Stress. Trait and State Anxiety were high in 5.4% (95% CI:4.2-6.6) and 8.1% (95% CI:6.6-9.6) of participants, respectively. Nurses' desire to leave the unit was associated with high burnout (adjusted odds ratio [ORa] 3.7, 95% CI:1.9-7.5) and Secondary Traumatic Stress (ORa 3.2, 95% CI:1.9-5.3), while the desire to leave the profession was related to high State Anxiety (ORa 12.5, 95% CI:4.6-33.7). Most participants (96.9%) were interested in receiving emotional management training.
Conclusions:
Continuous demands on oncology nurses' empathy can lead them to experience compassion fatigue, anxiety and a desire to leave the profession. The first study carried out with Spanish oncology nurses shows Compassion Fatigue is highly prevalent. This is related to nurses' desire to change units, leave their profession and has negative implications on staff satisfaction and quality of care. This problem justifies institutions support strategies for these professionals.
... Vicarious trauma (VT) occurs when the cumulative effect of working with traumatized individuals affects the cognitive schema of a provider changing how they process and perceive information (Nimmo & Huggard, 2013). Cognitive changes that may result from VT include alterations in spiritual beliefs, safety, or perception of control (Hernandez-Wolfe, Killian, Engstrom, & Gangsei, 2015). ...
Healthcare and social service providers play a critical role in supporting children, families and communities immediately after a disaster and throughout the recovery process. These providers, who may have also experienced the disaster and related losses, are among the least likely to receive mental health or psychological support which can result in burnout, secondary traumatic stress, depression and anxiety. Accessible psychosocial interventions designed for healthcare and social service providers in the aftermath of a disaster are therefore critical to recovery and to ensure providers are available to support families after future disasters. The purpose of this article is to describe Resilience and Coping for the Healthcare Community (RCHC), a manualized group work intervention for social service and health care providers who have provided care to children, families, and communities after a natural disaster. RCHC is currently being delivered in response to Hurricanes Harvey and Maria, storms that struck the gulf coast of the United States and the island of Puerto Rico in 2017. RCHC has also been used in the areas affected by Hurricane Sandy (New York and New Jersey), in Shreveport, Louisiana following severe flooding and in Saipan after a Typhoon devastated the island. Healthcare and social service providers who have received RCHC include the staff of Federally Qualified Health Centers and other community clinics, Disaster Case Managers, Child Care Providers, Mental Health Providers and First Responders. The health and wellbeing of these providers directly impacts their ability to provide quality care to families in their communities. This article presents the theoretical foundations of the RCHC intervention, describes the intervention in detail, provides a description of early and ongoing evaluation studies, and discusses the conditions for both implementation of RCHC and training of RCHC providers. The RCHC psychoeducational intervention provides education on, and strategies for, acute, chronic and post-traumatic stress, coping, and resilience, tailored for the needs of the helping professions. Through the use of individual and collective processing, healthcare and social service providers participating in RCHC develop both individual and collective coping plans. Considering the short and long-term impacts of disasters on communities’ essential healthcare and social service workforce, interventions like RCHC stand to provide essential benefits, including retention and wellbeing of providers of family services.
... In particular, trauma-informed principles call for clinics to establish true interdisciplinary partnership among staff, acknowledge and minimize power differences among staff, and proactively address the needs of staff. Such support is considered crucial because health care providers and clinic staff who work with traumatized patients may experience compassion fatigue, vicarious trauma, and secondary traumatic stress (Nimmo & Huggard, 2013), which can decrease client satisfaction (Baird & Jenkins, 2003;Brookings, Bolton, Brown, & McEvoy, 1985;Collins & Long, 2003;Finklestein, Stein, Greene, Bronstein, & Solomon, 2015;Kosny & Eakin, 2008;Leiter, Harvie, & Frizzell, 1998;Maslach & Jackson, 1981;Perry, 2014;Vahey, Aiken, Sloane, Clarke, & Vargas, 2004;Wies & Coy, 2013) as well as staff well-being. Clinic staff who have experienced trauma themselves may be at greater risk of being triggered about their own trauma, and thus experience distress when helping traumatized patients (Pearlman & Mac Ian, 1995). ...
Background:
Trauma-informed health care for women living with human immunodeficiency virus (HIV) attends not only to HIV treatment, but also to the many common physical and emotional health consequences of trauma. One principle of providing trauma-informed care is the acknowledgement that working with a population that has experienced extensive trauma affects the team members who care for them in the clinic, as well as the interactions between those team members.
Methods:
To understand the needs of one primary health care team, we conducted in-depth interviews with 21 providers, staff, and collaborators who provide care to patients within the clinic. We used symbolic interaction and grounded theory methods to examine how interactions unfold within the clinic and how they are influenced by trauma.
Results:
The clinic team serves a highly traumatized and vulnerable population. Within this context, interactions between clinic staff unfold and trauma surfaces, and power dynamics play out along the lines of professional hierarchy. Although power differences cause tension within the clinic, professional hierarchy also serves as an important division of labor in times of medical crises.
Conclusions:
Clinic power dynamics may be influenced to improve the care environment for patients, and to realize a more effective and satisfying trauma-informed health care clinic for both patients and staff.
... Helping professionals (e.g., social workers, therapists, and victim advocates) are frequently exposed to unpleasant life experiences due to their work (Huggard & Unit, 2013). Due to the high level of involvement in their clients' lives, providers may begin to experience adverse effects in the form of sleep disturbances, difficulties with interpersonal relationships, depression, anxiety, grief, physical aches and pains, and secondary traumatic stress (STS; Austin et al., 2009;Bride, 2004;Clark & Gioro, 1998). ...
Past research has investigated the rates of compassion satisfaction (CS), compassion fatigue (CF), and burnout within health-care providers. Findings indicate higher levels of CS and lower levels of CF predict lower rates of burnout. The current study extended prior research by replicating past research findings, but with victim advocates. This study enrolled a national sample of 142 victim advocates. A hierarchal linear regression was run to test the research questions. In level 1, years of experience was not significant and only accounted for 1.1% of the variance in burnout. When adding CS, the model became significant (p < .001) and CS accounted for an additional 51.8% of the variance. When CF was added to the final model, it was significant (p < .001), and accounted for an additional 19.3% of the variance. When comparing the findings to past studies, our findings were similar; however, our study did find that CS and CF accounted for significantly more variance than past studies with health-care providers. Therefore, CS and CF might be greater predictors of burnout in victim advocates than in health-care providers. Future studies should aim to create interventions to increase CS and decrease CF, to reduce burnout.
... Vicarious trauma is the change in worldview that takes place as the result of hearing an accumulation of traumatic stories over time. Arising from the helper's engagement with the traumatized client, vicarious trauma involves distress, specifically a change in the worker's cognitive schemata (Nimmo & Huggard, 2013). As with Post-Traumatic Stress Disorder, the change in worldview seen with people suffering from vicarious trauma may be a shift from altruism into pessimism. ...
Ongoing acute stress in humanitarian work leads to psychological distress among humanitarian workers. Stress management within humanitarian agencies requires responses at both the individual staff member and agency levels. Stress management is often conceptualized in four categories: stress that can be accepted; stress that can be altered; stress to which individuals can adapt; and stress that can be avoided. Humanitarian workers accept the stress created by the environment in which they choose to work. They can manage stress by altering their own behaviors through improved communication skills and the implementation of self-care plans. They can adapt, with the help of staff care plans such as counseling and peer support, to the stress created by their own histories of trauma or mental illness. The stress created by the workplace can be avoided. However, without a comprehensive support plan for mitigating psychological distress, both the individual humanitarian worker and the agency overall suffer. This article reviews current literature regarding the impact of avoidable stress and the impact of adaptation programs such as staff care and stress management plans on humanitarian work, and illustrates these impacts with a case example from the Danish Refugee Council, an international non-governmental organization with approximately 300 employees working in Greece.
... The distress that results from dissatisfaction is in fact associated with physiological hyperactivation, negative cognitions and negative mood, and has been associated with a wide variety of physical and mental health problems (Manocha et al., 2011). Including different conditions, such as overwork, unemployment or job insecurity and lack of family-work balance (Nakao, 2010), the appearance of specific phenomena (Collins & Long, 2003) such as Compassion fatigue (Figley , 2002), Secondary traumatic stress (Figley, 1995), Burnout (Maslash, 1982;Huggard & Unit, 2013;Ray et al, 2013). The result can lead to a reduction in the quality of care (Bültmann, 2002) to the abandonment of work (Medland et al., 2004). ...
Results: half of the participants in the study work during the night shift (50.6%), another percentage suffer from medical pathologies (41.6%) and follow drug therapies regularly (33.8%); significant positive correlations emerged among some MAWS scales (autonomous motivation, ego ideal - item 7,8, motivation for medical work - item 3,4) and psychological well-being; significant positive correlation between the POMS force scale and psychological well-being, among some POMS scales (Tension or Anxiety, Depression or Dejection, Fatigue or Inertia, Confusion or Bewilderment, Anger or Hostility, Vigor or Activity, Total score) and psychological distress and suffering; significant negative correlations among the POMS scales (Tension or Anxiety, Depression or Dejection, Anger or Hostility, Fatigue or Inertia, Confusion or Bewilderment, Total score) and psychological well-being, among the POMS, Vigor or Activity, psychological distress and suffering. Conclusions: in the field of work and the medical profession, the experience of this study refers to the importance of conscious and deep autonomy, as a possibility to adhere to the humanistic experience of the profession; the states of slight maladjustment can turn out to be particularly counterproductive, such as maladaptive psychopathological phenomena.
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.
Aim:
To explore the concept of vicarious trauma (VT) and clarify its fundamental meaning and distinctiveness as a psychological phenomenon experienced by nurses BACKGROUND: The current Covid19 pandemic has incited significant psychological distress on nursing professionals world-wide. There is growing knowledge of the negative outcomes of this distress including the manifestation of nursing burnout syndrome, compassion fatigue, and vicarious traumatization (VT). These concepts have often been used interchangeably throughout nursing discourse creating confusion surrounding their uses and unique attributes.
Design:
Walker and Avant's method of concept analysis RESULTS: VT is a psychological phenomenon that causes a permanent cognitive shift in the inner experience and world views of nurses after prolonged empathetic engagement with a patient's trauma. VT manifests as physical and emotional symptoms of distress, which can disrupt a nurses ability to provide competent care. Contradictions within the literature exist when defining VT, burnout syndrome and compassion fatigue, creating difficulty identifying attributes and consequences unique to VT.
Conclusion:
More empiric rigour is needed to adequately operationalize VT. Given the traumatic nature of the Covid19 pandemic, immediate policy and education attention should be directed towards understanding the relationship between nurses working during the Covid19 pandemic and the prevalence of VT. This article is protected by copyright. All rights reserved.
Mergers and Acquisitions it Process and Current Trends in India.
As a professional consequence of listening and striving to understand clients’ traumatic circumstances, a variety of professionals are at risk for burnout and trauma-related employment stress (TRES) conditions. In the words of van der Merwe and Hunt (Psychol Trauma Theor Res Pract Pol, 11(1):10–18, 2019), as professionals empathize with clients, their minds can be flooded with traumatic images resulting “in a diminishing of their capacity to contain, and not collapse under, the weight of another’s trauma” (p. 16). This chapter serves as an introduction to these job stress injuries and the concepts of burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. It begins with our attempt to define these constructs and report their risk factors. Next, it examines the prevalence of these challenges within various disciplines and then explores their physical, psychological, and organizational consequences. Finally, the purpose of this book is overviewed, focusing on the technique of acceptance and commitment therapy (ACT) as an intervention for burnout and TRES.
New paradigms for curriculums designing in health professions defend the inclusion of structured methodologies to train comprehensive skills for problem-solving. This paper aimed to characterize the physiotherapy students’ problem-solving experiences using a collaborative modern board game (MBG). An exploratory study was performed with a purposive sample of 17 physiotherapy students recruited from the School of Health Sciences of Polytechnic Institute of Leiria. Participants were included if they were: 18 yrs.; physiotherapy students and agreed to voluntarily participate. They participated in a 2-hours learning experience using the MBG TEAM 3, that is played in teams of three players, with each player taking different roles: the monkey who cannot speak, the monkey who cannot see, the monkey in the middle. At the end, each participant fulfills a questionnaire about the personal experience in the following domains, using a Likert scale of 1- 7 (I total agree): Team working (TW) (personal feeling of competence to play -TW1; empathy to other players - TW2); innovative and creative thinking (ICT) (creative expression of opportunities - ICT1; freedom to experiment new things - ICT2). Descriptive statistics and the Spearman rank were calculated to characterize students’ perspectives and to describe relationships between TW abilities and ICT. Participants (4 males; 20.14±4.34 yrs.) presented the following mean values ICT1(5.05±1.24); TW2(6.05±0.97); ICT1(4.95±1.40); ICT2(5.85±0.96). The TW1 was significantly correlated with ICT1 (r=0.44; p=0.048*); ICT2 (r=0.45; p=0.041*). This study demonstrated the potential of MBG to characterise and monitor personal learning experiences in problem-solving scenarios for physiotherapy students.
Background
Secondary traumatic Stress (STS) is an increasingly recognized phenomenon experienced by clinicians working with patients who have experienced trauma firsthand. STS is experienced in a range of clinical settings; medical trainees and those working in Child Abuse Pediatrics (CAP) are at particular risk of experiencing STS. To date, there are no interventions described to address STS experienced by medical trainees in the context of CAP training.
Objective
The aim of this project was to design and pilot an innovative program to increase resilience and address STS symptoms among fellows in a CAP training program.
Participants and setting
The Therapeutic Group Sessions (TGS) program was developed for CAP fellows at the Hospital for Sick Children, Toronto, Canada.
Methods
The intervention involved mandatory, monthly small group sessions facilitated by a consistent mental health professional throughout fellowship. Sessions included low intensity focusing activities, sharing impactful work-related experiences, mental health professional-led discussion of strategies and reflection on the session. Written evaluations were completed to understand the perceived impact on fellows and were analyzed for themes.
Results
Fellows reported improvements in perceived STS symptoms and increased feelings of resilience. Unanticipated positive outcomes were described including, a highly bonded fellowship group and transferrable skills gained in supportive communication. Programs developed to support clinicians in other settings are reviewed and compared to the TGS program.
Conclusions
This is the first program aimed at improving resilience and addressing STS among child abuse fellows. Outcomes demonstrated numerous positive impacts that are widely applicable to the broader clinical setting.
Bir ruhsal sağlığı bozukluğu olarak ele alınmayan ancak semptom kümesi olarak değerlendirilen Tükenmişlik kavramının değerlendirilmesi ve araştırılması günümüz modern dünyasından mental iyi oluş açısından büyük önem taşımaktadır. Yardım ilişkisi içerisinde olunan mesleklerde daha fazla görülen Tükenmişlik Sendromu pek çok bireysel ve çevresel sebepten dolayı Psikolojik Danışmanlar arasında da sıklıkla görülmektedir. Bu araştırmanın amacı Türkiye’de farklı kurum ve kuruluşlarda görev yapan psikolojik danışmanların deneyimlediği Tükenmişlik düzeylerini çeşitli değişkenler yardımıyla incelemektir. Bu doğrultuda alanyazında yer alan çalışmalar belirli dahil etme dışlama kriterleri doğrultusunda Sistematik gözden geçirme yöntemi ile değerlendirilmişir. Sonuçlar genç psikolojik danışmanların kişisel başarı boyutunda daha fazla tükenmişlik yaşadığını, cinsiyete göre ise bir farklılaşma olmadığını ortaya koymuştur. Tükenmişlik düzeyi medeni durum, kıdem, çalışılan kurum gibi değişkenler açısından da detaylı olarak incelenmiştir.
Violence intervention programs aim to help clients overcome trauma, but, due to the demands of their profession, caseworkers are at risk for experiencing low compassion satisfaction and high compassion fatigue. This cross-sectional study sought to describe the prevalence of compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress [STS]) among 93 caseworkers. Participants completed the Professional Quality of Life Survey at a conference for a national network of hospital-based violence intervention programs in September 2018. Results displayed high compassion satisfaction across demographic groups, while participants significantly differed in compassion fatigue by years of experience and workplace setting. Caseworkers who had been working in their profession for 6–10 years experienced higher levels of burnout than those working fewer years (p = 0.02). Further, caseworkers employed in a single program setting experienced significantly lower levels of STS than those who work in both a community and hospital setting (p = 0.01). This analysis stands in contrast to previous studies showing higher levels of compassion fatigue in younger, and less experienced healthcare workers. Further studies are warranted to determine how the prevalence of compassion fatigue in victim advocates compares to those of other healthcare providers and which interventions can best promote compassion satisfaction.
Objective:
This study aims to evaluate the incidence of secondary traumatic stress in Obstetrics and Gynecology physicians including symptoms, impact, and programmatic needs for support.
Design:
This study used a mixed-methods approach comprised of an anonymous online survey and individual interviews/focus groups. IBM SPSS 24.0 generated statistical analysis: descriptive statistics, Fisher's exact test to compare nominal survey data and across groups, phi correlations (ϕ) and interitem reliability (Cronbach alpha). Constant comparative qualitative analysis determined cross-cutting themes. Research was approved by institutional IRB.
Setting:
This study was conducted at the Medical College of Wisconsin, Milwaukee, Wisconsin, a large academic medical institution.
Participants:
Participants were recruited from the Department of Obstetrics & Gynecology via email. Faculty, fellows, and residents participated in an anonymous online survey and were invited to complete individual interviews or focus groups. The online survey was distributed to 67 clinical faculty, residents, and fellows with a total of 27 individuals completing the reliable (alpha = 0.71) anonymous survey (40% response rate). Ten faculty participated in individual interviews or focus groups.
Results:
Respondents to the quantitative survey identified involvement in adverse medical events (95%) and symptoms of traumatic stress (75%). Anxiety (81%), guilt (62%), and disrupted sleep (58%) were most frequently reported symptoms (mean number of symptoms = (3.4(±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (ϕ = 0.5, p < 0.006); those reporting guilt would go to friends (ϕ = 0.5, p < 0.007). Disrupted sleep more commonly led to seeking mental health services (ϕ = 0.5, p < 0.007). Desire for support varied. Those reporting anxiety were interested in peer-to-peer responders (ϕ = 0.6, p < 0.001); those reporting guilt would use debriefing sessions (ϕ = 0.4, p < 0.023). Qualitative data from individual interviews and focus groups yielded descriptions of physical and cognitive symptoms associated with second victim experiences included responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Identified resources for coping: just culture, collegial support, peer-to-peer responders, and structured case conferences for emotional debriefing.
Conclusions:
Obstetrics and Gynecology providers are likely to experience symptoms of secondary traumatic stress following adverse patient events similar to other medical specialties. Comprehensive programs to address emotional well-being of physicians are important to promote collegiality and reduce symptoms of secondary traumatic stress. Safety and transparency with opportunities for group processing are identified as essentials for positive institutional culture, as well as peer support programs.
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.
Objectives
To examine the associations and the mechanisms between caregiver burden and compassion fatigue among family caregivers.
Method
A cross-sectional study comprising 300 family caregivers of older relatives in Arab communities in Israel was conducted. Data were collected via face-to-face interviews in Arabic using structured questionnaires to identify factors associated with compassion fatigue (using a secondary traumatization stress scale). Bootstrapping with resampling strategies tested the multiple mediator model.
Main findings
The results show a significant total effect of caregiver burden on compassion fatigue ( b = 3.79, t(300) = 3.47, p < .001; R ² =.50). This association was found to be partially mediated by family support ( B = .81, 95% confidence interval [CI] = 0.23, 1.85) and disengagement coping ( B = .97, 95% CI = 0.19, 2.14), but was not mediated by engagement coping strategies.
Conclusion
Compassion fatigue is prevalent among family caregivers and requires more attention from professionals and policymakers.
Background In 2014, in Brussels, a group of undocumented migrant workers started a hunger strike. A loophole in Belgian migration law allows very sick people to stay in the country to recuperate. Undocumented migrants jeopardize their health to be able to obtain a temporary permit and a way out of misery. The monitoring of the hunger strike was done by young, committed but inexperienced health professionals.
Methods At the end of the hunger strike, two focus groups were held to find out the dilemmas confronting the health professionals.
Results Eighteen out of 29 health professionals participated. They mentioned their curiosity to gain new insights into living conditions among undocumented people and the reasons why they started the strike. They were puzzled by the paradox of wanting to die to get a better life and refusing medical advice. They wondered about their role and commitment as a caregiver. Some were deeply touched by the experience and reacted emotionally while others deepened their engagement. Symptoms of Secondary Traumatic Stress, such as re-experiencing and avoidance were observed. The participants themselves also proposed improvements to the monitoring.
Conclusions Even though only a small number of health professionals were questioned, we detected a lot of preoccupations and contradictions in their reactions. To be able to process these a close follow-up and evaluation of the monitoring of a hunger strike is mandatory. We also propose that prevention, early detection and treatment of Secondary Traumatic Stress should become part of formal medical education.
Screening rates for trauma are low in health care settings. We examined the association between health care providers’ (HCPs) experience of physical or sexual trauma and their screening of female patients for trauma. HCPs at an urban academic medical institution were surveyed from September through November 2016. The Brief Trauma (BTQ) and Sexual and Physical Abuse History Questionnaires (SPAHQ) assessed their own experiences of trauma. The Screening Practices Questionnaire (SPQ) assessed HCPs trauma screening. Multiple regression analyses were performed. Among 212 respondents aged 22–67 years, most were female (78.3%) and white (76.1%). Nurses (41.0%) were the largest occupational group. Overall, 85.8% reported having experienced trauma. No significant difference was observed in median SPQ scores between HCPs who had experienced trauma (3.88 [Interquartile Range (IQR) 3.44–4.31]) and those who had not (4.00 [IQR 3.47–4.33], p = .645). In an adjusted model, screening policy awareness and having an obstetrics & gynecology or psychiatry specialty were associated with higher SPQ scores (p < .001). The prevalence of trauma experience in this sample was high, but not associated with screening. Screening policy awareness and practice specialty were associated with screening. HCP factors associated with greater trauma screening should be explored.
Homelessness continues to be a pervasive problem nationally and internationally. In the USA, the National Law Center on Poverty and Homelessness has estimated the annual number of homeless individuals to be in the range of 9.9–10.9 million sheltered and unsheltered persons, including those who have moved in with others due to financial hardship. Many of these persons suffer from severe mental illness or chronic substance abuse disorders. Additionally, many homeless persons have trauma histories, including abuse, neglect, and family and community violence. Many more have also experienced the traumatic effects of homelessness itself, including violence, revictimization, stigma, hunger, poor health, and other negative outcomes. To address the ongoing effects of traumatic stress, homelessness service settings are implementing trauma-informed care (TIC). This chapter will review the tenets of TIC and examine the personal and organizational barriers that may impede its successful implementation. Strategies for overcoming these barriers will also be highlighted.
Traumatic experiences can have life-long effects on a person’s health, well-being, and longevity. Preventing trauma and addressing its harmful sequelae require reorienting patient care, clinical operations, organizations, and community engagement to support resilience and healing. An approach informed by cultural humility that addresses unequal power imbalances and asks the question, “What happened to you?” rather than “What’s wrong with you?”, trauma-informed care promotes health equity in direct patient care, organizations, and communities. This chapter presents the foundational principles and mission of trauma-informed care and a practical framework called the 4 Cs (Calm, Contain, Care, and Cope) to transform theory into practice.
Learning how to conduct qualitative research may seem daunting for those new to the task, especially given the paradigm ’s emphasis on complexity and emergent design. Although there are guidelines in the literature, each project is unique and ultimately the individual researcher must determine how best to proceed . Reflexivity is thus considered essential, potentially facilitating understanding of both the phenomenon under study and the research process itself . Drawing upon the contents of a reflective journal, the author provides an inside view of a first project, making connections between theory and practice. This personal narrative highlights the value of reflexivity both during and after a study, and may help to demystify the research process for those new to the field.
This is the book that started an are of research and practice of compassion fatigue, secondary traumatic stress and stress reactions, vicarious trauma, and most recently compassion fatigue resilience
This brief book brings together researchers and practitioners from medicine, nursing, psychiatry, psychology, social work, marriage and the family and others to explain, measure, prevent, and treat compassion fatigue. This the introduction and other front matter for the book.
The great controversy about helping-induced
trauma is not “Can it happen?” but “What shall we
call it?” After reviewing nearly 200 references from
PILOTS, Psychlit, Medline, and Social Sciences In
dex, it is apparent that there is no routinely used
term to designate exposure to another’s traumatic
material by virtue of one’s role as a helper. Four
terms are most common: “compassion fatigue” (CF);
“countertransference” (CT); “secondary traumatic
stress” (STS); and “vicarious traumatization” (VT).
Work-related secondary traumatic stress. Available from: https://www.researchgate.net/publication/290118676_Work-related_secondary_traumatic_stress [accessed Jun 14 2018].
Compassion fatigue, also referred to as secondary traumatic stress, is increasingly being acknowledged as a possible consequence of working in any helping and caring profession. Previous research has focused on examining this construct in a variety of health professionals - social workers, counsellors, psychologists and nurses; however, little attention has been paid to this experience in doctors. This research examined the presence of compassion fatigue in doctors. A self-selected sample of 253 doctors, working in four locations in New Zealand and training in a variety of specialty disciplines, participated in this research by completing an anonymous questionnaire which included the ProQOL (Professional Quality of Life) instrument. This instrument measures compassion fatigue, burnout and compassion satisfaction. Results indicated that 17.1% of the sample appeared to be at risk for compassion fatigue as indicated by a high score on that subscale of the ProQOL, and 19.5% at risk of burnout. These results are similar to those reported in studies of other health professionals and suggest a need for caution on the part of clinicians and employers as to the potentially emotionally demanding aspects of patient care.
This study investigated the incidence and nature of traumatic experiences that educators encounter in their work, and examined the effects of these experiences. Traumatic exposure in the classroom is viewed against the backdrop of educators' personal and professional experiences, and the levels of compassion fatigue, compassion satisfaction and burnout were measured. The ways in which schools and educators deal with the effects of trauma were also explored. A sample of 146 educators from around the country completed two questionnaires. One questionnaire posed questions with regard to the incidence, nature and effects of trauma in the learning environment. The other questionnaire was the Compassion Fatigue Self-Test for Helpers (Figley, 1999:18-19). Both quantitative and qualitative analysis were used to make meaning of the data collected. The study revealed that educators are exposed to a high incidence of trauma as a result of violence, death and abuse in the community. The effects are largely negative, but some positive effects were also identified. The Compassion Fatigue questionnaire revealed that almost half the educators experience extremely high levels of Compassion Fatigue. An important finding of this study is that even a short course in dealing with the effects of trauma, significantly increases educators' Compassion Satisfaction. Sadly, approximately a third of the educators feel that their coping strategies are inadequate given the realities of their work lives.
Vicarious traumatization (VT) refers to harmful changes that occur in professionals’ views of themselves, others, and the world, as a result of exposure to the graphic and/or traumatic material of their clients. Secondary traumatic stress (STS) refers to a set of psychological symptoms that mimic post-traumatic stress disorder, but is acquired through exposure to persons suffering the effects of trauma. Numerous studies have sought to identify correlates of both VT and STS, yet there still exists a lack of conceptual clarity in the literature about VT, STS, and the related constructs of burnout and compassion fatigue. This has made it difficult to use the literature to inform practice and training. This study clarifies the definitions of VT and STS and uses levels of evidence analysis to synthesize the research findings to date. Originally planned as a meta-analysis, the study was re-designed as methodological issues in the literature became apparent that would call into question the validity of a meta-analysis. The current method of analysis documents the degree of evidence for the most commonly researched factors that have been researched as possible contributors to the development of both VT and STS, synthesizing the findings of published research and dissertations written in the English language from 1994–2003. Findings indicate that persuasive evidence exists for personal trauma history, reasonable evidence for perceived coping style, and some evidence for supervision experiences, as important predictors of VT. Persuasive evidence for amount of exposure to trauma material and reasonable evidence for personal trauma history are indicated as important in the development of STS. Limitations of the current study and directions for further research are discussed. *An earlier version of this paper was presented at the 112th Annual Conference of the American Psychological Association, 31 July 2004, Honolulu Hawaii, USA
Objective: To describe the development and validation of the Secondary Traumatic Stress Scale (STSS), a 17-item instrument designed to measure intrusion, avoidance, and arousal symptoms associated with indirect exposure to traumatic events via one's professional relationships with traumatized clients. Method: A sample of 287 licensed social workers completed a mailed survey containing the STSS and other relevant survey items. Results: Evidence was found for reliability, convergent and discriminant validity, and factorial validity. Conclusions: The STSS fills a need for reliable and valid instruments specifically designed to measure the negative effects of social work practice with traumatized populations. The instrument may be used to undertake empirical investigation into the prevention and amelioration of secondary traumatic stress among social work practitioners.
A mailed survey of 225 National Association of Alcohol and Drug Addiction Counselors members was conducted to examine trauma training, trauma practices, and secondary traumatic stress among substance abuse counselors. Results indicate that most substance abuse counselors are not being prepared for practice with traumatized populations in their formal academic training, although many obtained some trauma training through continuing education activities. There is a great deal of variation in terms of counselors' practices in the assessment and treatment of traumatic stress. Last, substance abuse counselors are highly likely to be secondarily exposed to traumatic events through their work with traumatized populations, and many experience at least some symptoms of secondary traumatic stress. The experience of secondary traumatic stress is believed to contribute to turnover and may reduce the quality and effectiveness of services. These findings highlight the need to attend to the issue of secondary traumatic stress among substance abuse counselors.
discusses the emergence of information that forms the basis of our understanding of Compassion Fatigue and Compassion Stress / recognize that something specific must be done to counteract the challenges of Compassion Stress and Fatigue / we now know . . . that something can be done to help caring [health] professionals / we can help professionals to recognize their shortcomings—their special vulnerability to Compassion Stress and Fatigue—and help them cope more effectively with the cost of caring / there is no doubt that traumatic events will continue to occur and affect hundreds of thousands of people each year / these traumatized people require the services of professionals who are well prepared to help and, in turn, to help themselves / therefore, we need to keep these caring professionals at work and satisfied
why are there so few reports of secondary trauma / why STSD [secondary traumatic stress disorder] / definition of secondary traumatic stress [STS] and stress disorder / contrasts between STS and other concepts / countertransference and secondary stress / burnout and secondary stress / why Compassion Stress and Compassion Fatigue / implications for training and educating the next generation of professionals (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This manuscript provides practitioners a gateway into understanding assessment instruments for compassion fatigue. We first
describe and then evaluate the leading assessments of compassion fatigue in terms of their reliability and their validity.
Although different instruments have different foci, each described instrument measures at least one component of compassion
fatigue. The final section discusses three factors in selecting a compassion fatigue measure: the assessment domain or aspect
of compassion fatigue to be measured; simultaneous measurement, and; timeframe of what is being measured. Finally, we caution
about interpreting scores since the measures were developed as screening devices.
The primary aim for this research was to explore the overlap and differences between the concepts related to secondary traumatization: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), compassion fatigue (CF), and burnout (BRN). A secondary aim for this research was to examine the impact of secondary traumatization and some of the personal and professional elements that affect how pediatric healthcare providers experience PTSD, STS, CF, and BRN. An online survey was sent via e-mail to numerous list serves for healthcare providers who had worked on PICU, NICU, or PEDS units within the last year. The analyses revealed that a significant overlap existed between the terms of STS, PTSD, BRN, CS, and CF for PICU, NICU, and PEDS providers. However, a hierarchical linear regression revealed a significant amount of unique contributions to the variance in CF based on each of the measured concepts. Despite previous literature that indicates that the terms STS and CF can be used interchangeably, the two most prominent measures utilized in the assessment of CF and STS are actually capturing at least some unique elements. Given these results, future researchers should examine and conceptualize the difference in etiology, prevalence, symptoms, and treatment efficacy for CF and STS as separate but related entities and then return their focus to understanding secondary traumatization in healthcare providers.
Junior doctors face specific pressures related to their professional stage and development and can be at risk of poor health. A confidential survey conducted in 2008 by the Australian Medical Association Council of Doctors in Training investigated the health and wellbeing of junior doctors. There were 914 completed surveys: 71% of junior doctors were concerned about their own health, and 63% about the health of a colleague. A majority of junior doctors met well established criteria for low job satisfaction (71%), burnout (69%) and compassion fatigue (54%). The early stages of a medical career are demanding, and the health and wellbeing of junior doctors must be a personal priority, as well as the responsibility of the medical profession in general, to ensure a healthy medical workforce in the future.
The World Health Organization estimates a current global shortage of 4.3 million health workers. Australia and New Zealand compare unfavourably with other Organisation for Economic Co-operation and Development (OECD) countries in respect to doctor numbers. The overall shortage of doctors in Australia and New Zealand is exaggerated by the disciplinary, cultural and demographic maldistribution of the doctors relative to need and utility. Australia and New Zealand are the most reliant of the OECD countries on foreign doctors. An increase in spending on health promotion and disease prevention is essential. However, it is unlikely that the demand for doctors will be significantly reduced by compressions of morbidity in the later years of life or that there will be a substantive increase in either the percentage of the community employed in health services or in the output from the current workforce. Doctor shortages are better addressed by alignment of elements of the education and health systems with each other and with patient care needs, and by innovative health provider training and employment.
Psychotherapists who work with the chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests that psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue.
This study explores the formulation of a new concept: vicarious resilience. It addresses the question of how psychotherapists who work with survivors of political violence or kidnapping are affected by their clients'stories of resilience. It focuses on the psychotherapists' interpretations of their clients' stories, and how they make sense of the impact that these stories have had on their lives. In semistructured interviews, 12 psychotherapists who work with victims of political violence and kidnapping were interviewed about their perceptions of their clients' overcoming of adversity. A phenomenological analysis of the transcripts was used to describe the themes that speak about the effects of witnessing how clients cope constructively with adversity. These themes are discussed to advance the concept of vicarious resilience and how it can contribute to sustaining and empowering trauma therapists.
Previous investigations of the impact of trauma-related psychotherapy on clinicians have emphasized the hazardous nature of such work. The present study is the first exploration of clinicians’ perceptions of trauma work to investigate in depth the positive consequences of working with trauma survivors. A sample of 21 psychotherapists participated in a naturalistic interview exploring the impact of trauma work with a particular focus on (a) changes in memory systems and schemas about self and the world (the hallmarks of vicarious traumatization) and (b) perceived psychological growth. In addition to reporting several negative consequences, all of the clinicians in this sample described positive outcomes. These descriptions of positive sequelae are strikingly similar to reports of growth following directly experienced trauma and suggest that the potential benefits of working with trauma survivors may be significantly more powerful and far-reaching than the existing literature’s scant focus on positive sequelae would indicate.
There were two aims of the research with 190 Australian clinical psychologists: (1) to investigate the construct validity of the Therapist Belief Scale (TBS), and (2) to examine the relative contribution of demographics, workplace variables, and individual factors to burnout. Construct validity was examined using exploratory and confirmatory factor analyses and associations between the variables. Multivariate regressions were used to examine the relative contributions to burnout. The TBS showed three factors related to distress, inflexibility, and control, all of which were significantly associated with lower levels of personal accomplishment. Multivariate analyses showed emotional exhaustion to be associated being a woman, working for the government, having less personal resources, and endorsing more therapist beliefs related to control. Higher levels of personal accomplishment were significantly associated with a lower annual income, not having a mixed caseload, having more personal resources, and endorsing lower levels of therapist beliefs related to inflexibility and control.
Vorgelegt wird eine Übersicht über wissenschaftliche Konzepte und psychologische sowie klinisch-psychosomatische Aspekte des Burn-out-Syndroms. Nach neueren Untersuchungen befinden sich in Deutschland bis zu 25 % der insgesamt etwa 36 Millionen Erwerbstätigen in einer gesundheitlichen Situation, die der New Yorker Arzt und Psychoanalytiker Herbert J. Freudenberger 1974 erstmals als Burn-out-Syndrom bezeichnet hat. Burn out-Dimensionen sind: 1. emotionale Erschöpfung (emotional exhaustion), 2. eine gefühllose, gleichgültige oder zynische Einstellung gegenüber Klienten, Kunden oder Kollegen (depersonalisation) sowie 3. eine negative Einschätzung der persönlichen Leistungskompetenz (low personal accomplishment). Erwerbstätige mit Burn-out-Syndrom leiden an einer breiten Palette psychosomatischer Beschwerden: Schlafstörungen, chronische Schmerzen ohne Befund, funktionelle Herz-Kreislauf-Beschwerden sowie unspezifische Beschwerden des Magens und des Darmes. Als Ursachen des Burn-out-Syndroms werden diskutiert: 1. hohe Belastung und Eintönigkeit bei gleichzeitig geringer Möglichkeit zur Einflussnahme auf den Arbeitsprozess, 2. geringe Anerkennung bei zugleich starker persönlicher Verausgabung, 3. schließlich fehlende soziale Unterstützung durch Vorgesetzte und Kollegen sowie im persönlichen Umfeld. Wirksamste Prävention des Burn-out-Syndroms sind psychotherapeutisch moderierte Supervisionsgruppen für Mitarbeiter und Vorgesetzte. Bei bereits vorhandenen Burn-out-Symptomen sollte eine ambulante bzw. stationäre psychosomatisch-psychotherapeutische Therapie genutzt werden, um vorzeitige Dienst- oder Berufsunfähigkeit abzuwenden.
Counselors in all settings work with clients who are survivors of trauma. Vicarious trauma, or counselors developing trauma reactions secondary to exposure to clients' traumatic experiences, is not uncommon. The purpose of this article is to describe vicarious trauma and summarize the recent research literature related to this construct. The Constructivist Self‐Development Theory (CSDT) is applied to vicarious trauma, and the implications CSDT has for counselors in preventing and managing vicarious trauma are explored.
This study examined vicarious trauma in clinicians who provide sexual abuse treatment (N = 383). A random sample of clinical members from the Association for the Treatment of Sexual Abusers and American Professional Society on the Abuse of Children were surveyed. Vicarious trauma was measured using the Trauma Stress Institute Belief Scale (Pearlman, 2003). Maltreatment was measured using the Childhood Trauma Questionnaire (Bernstein & Fink, 1998). Respondents reported high rates of childhood maltreatment. Simultaneous multiple regression analyses were used to examine relationships between gender, age, maltreatment history, and vicarious trauma. Male gender predicted greater disrupted cognitions about self-esteem and self-intimacy. Clinician age and childhood emotional neglect predicted greater disrupted cognitions about self-intimacy. Implications for education, practice, and research are discussed.
Within the context of their new constructivist self-development theory, the authors discuss therapists'' reactions to clients'' traumatic material. The phenomenon they term vicarious traumatization can be understood as related both to the graphic and painful material trauma clients often present and to the therapist''s unique cognitive schemas or beliefs, expectations, and assumptions about self and others. The authors suggest ways that therapists can transform and integrate clients'' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects.
Restricted Item. Print thesis available in the University of Auckland Library or may be available through Inter-Library Loan. [no abstract available]
A new form of literature review has emerged, Mixed Studies Review (MSR). These reviews include qualitative, quantitative and mixed methods studies. In the present paper, we examine MSRs in health sciences, and provide guidance on processes that should be included and reported. However, there are no valid and usable criteria for concomitantly appraising the methodological quality of the qualitative, quantitative and mixed methods studies.
To propose criteria for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies or study components.
A three-step critical review was conducted.
2322 references were identified in MEDLINE, and their titles and abstracts were screened; 149 potentially relevant references were selected and the full-text papers were examined; 59 MSRs were retained and scrutinized using a deductive-inductive qualitative thematic data analysis. This revealed three types of MSR: convenience, reproducible, and systematic.
Guided by a proposal, we conducted a qualitative thematic data analysis of the quality appraisal procedures used in the 17 systematic MSRs (SMSRs).
Of 17 SMSRs, 12 showed clear quality appraisal procedures with explicit criteria but no SMSR used valid checklists to concomitantly appraise qualitative, quantitative and mixed methods studies. In two SMSRs, criteria were developed following a specific procedure. Checklists usually contained more criteria than needed. In four SMSRs, a reliability assessment was described or mentioned. While criteria for quality appraisal were usually based on descriptors that require specific methodological expertise (e.g., appropriateness), no SMSR described the fit between reviewers' expertise and appraised studies. Quality appraisal usually resulted in studies being ranked by methodological quality.
A scoring system is proposed for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies for SMSRs. This scoring system may also be used to appraise the methodological quality of qualitative, quantitative and mixed methods components of mixed methods research.
Work strain has been argued to be a significant cause of absenteeism in the popular and academic press. However, definitive evidence for associations between absenteeism and strain is currently lacking. A theory focused meta-analysis of 275 effects from 153 studies revealed positive but small associations between absenteeism and work strain, psychological illness, and physical illness. Structural equation modeling results suggested that the strain-absence connection may be mediated by psychological and physical symptoms. Little support was received for the purported volitional distinction between absence frequency and time lost absence measures on the basis of illness. Among the moderators examined, common measurement, midterm and stable sources of variance, and publication year received support.
The Quality of Reporting of Meta-analyses (QUOROM) Conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs).
The QUOROM group consists of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items.
The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. it is organized into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with 'trial flow', study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials.
We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Vicarious trauma (VT) and secondary traumatic stress (STS) or compassion fatigue both describe effects of working with traumatized persons on therapists. Despite conceptual similarities, their emphases differ: cognitive schemas vs. posttraumatic symptoms and burnout, respectively. The TSI Belief Scale (TSI-BSL) measures VT; the Compassion Fatigue Self-Test (CFST) for Psychotherapists measures STS. Neither has substantial psychometric evidence yet, nor has their association been studied. Results for 99 sexual assault and domestic violence counselors show concurrent validity between TSI-BSL and CFST, moderate convergence with burnout but useful discrimination, and strong convergence with general distress, but adequate independent shared variance. Counselors with interpersonal trauma histories scored higher on CFST, but not TSI-BSL or burnout, consistent with the CFST's emphasis on trauma symptomatology.
The burgeoning of the research literature has made it increasingly difficult for clinicians to keep up to date with recent advances. It is well recognised in general medicine that knowledge from traditional sources, such as expert clinicians and textbooks, may be out of date, unreliable, or even frankly erroneous [1]. There is no reason to assume that the situation would be different in psychiatry, psychology or psychosomatic medicine. Given the difficulties in keeping up with all the individual papers published, one solution is to rely on secondary sources, notably overviews and meta-analyses. However, even these knowledge sources have grown exponentially (fig. 1).
Understanding the effects of prolonged contact, in a professional role, with trauma victims has led to conceptualizations of helper stress. Various terms such as compassion fatigue, vicarious traumatization, secondary traumatic stress reactions, empathic strains, burn out, and Type land Type II countertransference have been proposed These terms required conceptual classification to make a proper diagnosis and classification of their impact on the helping process. It is proposed that Traumatoid States is a more inclusive and accurate term to define sub-types of occupationally-related stress response syndromes (OSRS).
Experience suggests that individuals working in the caring and psychotherapeutic professions are among those to provide mental health services to disaster victims suffering from psychological trauma following catastrophic events. Yet, few studies have focused on the emotional exhaustion from working with such clients, referred to as compassion fatigue (CF) in this study, and how CF differs from other occupational hazards, such as secondary trauma (ST) and job burnout. In the present study, we used recently validated scales to predict ST and job burnout related to providing services to those affected by the World Trade Center (WTC) attacks. Our study data were based on a random survey of 236 social workers living in New York City (NYC), over 80% of which reported being involved in post-WTC disaster counseling efforts. Our analyses indicated that controlling for demographic factors, years of counseling, and personal trauma history, ST was positively associated with WTC recovery involvement (p <. 001) and negatively associated with having a supportive work environment (p < . 01). In contrast, job burnout was negatively associated with having a supportive work environment (p < .01), but not associated with WTC involvement or WTC counseling efforts. We discuss these results in light of future conceptual and empirical research needs.
This study examined vicarious trauma effects in male and female clinicians who treat sexual abuse survivors (n = 111) and sexual offenders (n = 272). The national survey was conducted using a random sample of clinical members of two professional organizations. Analyses tested the relationships between demographic variables, maltreatment history, client population served, and cognitions about trust of and intimacy with others, using the Trauma Stress Institute Belief Scale (TSIBS-R-L, Pearlman 2003), the Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998), and author-generated questions. Respondents reported high rates of multiple forms of childhood maltreatment; however there was no relationship between history of child sexual abuse and vicarious trauma effects. Scores for self-reported disruption in cognitions about intimacy with others exceeded norms for mental health professionals. Sequential regression analyses were used to examine theoretically-derived variables. Implications for practice and research are detailed.
Few studies have focused on caring professionals and their emotional exhaustion from working with traumatized clients, referred to as compassion fatigue (CF). The present study had 2 goals: (a) to assess the psychometric properties of a CF scale, and (b) to examine the scale's predictive validity in a multivariate model. The data came from a survey of social workers living in New York City following the September 11, 2001, terrorist attacks on the World Trade Center. Factor analyses indicated that the CF scale measured multiple dimensions. After overlapping items were eliminated, the scale measured 2 key underlying dimensions--secondary trauma and job burnout. In a multivariate model, these dimensions were related to psychological distress, even after other risk factors were controlled. The authors discuss the results in light of increasing the ability of professional caregivers to meet the emotional needs of their clients within a stressful environment without experiencing CF.
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