Sjuksköterskans arbete, förhållningssätt och arbetsmiljö regleras i etiska koder, lagar och förordningar. Hen visar omsorg om patienten genom omvårdnad i dennes hela kontext. Trenden är att sjuksköterskan skall vårda personcentrerat och inte bara utföra uppgifter av teknologisk karaktär, det förstnämnda ställer krav på empati. En god omsorg och ett personcentrerat arbetssätt kan ses som en utmaning att hantera i sjuksköterskans arbetsmiljö. När sjuksköterskan inte klarar detta kan hen utveckla samvetsstress. Litteraturöversikten syftade till att beskriva upplevelsen av samvetsstress. Artikelsökning i databaser på termen compassion fatigue genomfördes och en blandning av kvalitativa och kvantitativa studier från Nordamerika, Kina och Portugal granskades. Totalt 12 artiklar samt en avhandling inkluderades i översikten. Resultatet delades in i tre huvudkategorier och totalt 14 subkategorier. Kategorierna besvarar frågeställningarna: faktorer som påverkar samvetsstress, symtom på samvetsstress och hur sjuksköterskor hanterar samvetsstress. Påverkansfaktorer var erfarenhet, förmåga till gränssättning, organisatoriska faktorer och svåra etiska frågeställningar. Symtomen var avskärmning, minskad tolerans, upplevelse av inkompetens och fysisk utmattning. Sjuksköterskan hanterar samvetsstress genom att prioritera sitt sociala liv, söka ledighet, byta patient, utbilda sig och byta arbete. I studier inom området råder en viss begreppsförvirring och olika forskare studerar och tolkar begreppen olika. Sjuksköterskor och organisationer har en begränsad kunskap om fenomenet. Bredden i funna studier bidrar med kunskapsunderlag om fenomenet samvetsstress. Utbildningsinsatser om fenomenet samvetsstress både inom utbildningsväsendet, för organisationen och sjuksköterskor i klinisk verksamhet är indicerat för att arbeta preventivt mot utveckling av samvetsstress.

abstract: In the past decade, research has demonstrated the relationship between higher levels of self-compassion and lower levels of negative psychological outcomes. More recently, the concept of self-compassion has been explored within the context of various health behaviors. Very few studies have investigated the potential relationship between self-compassion and eating behaviors. Based on literature and the established relationship between negative self-evaluation and abnormal eating behaviors/eating disorders, the current study sought to examine correlations between self-compassion, eating behaviors, and stress in first time college freshmen. The study population consisted of 1478 participants; ages 18-22 years; females = 936 (63%), males = 541 (37%). Participants self-reported measures of the Perceived Stress Scale (PSS), the Three Factor Eating Questionnaire (TFEQ), and the Self Compassion Scale (SCS). PSS score, the overall score and individual subscale scores of SCS, and the three subscale scores of the TFEQ (restraint, disinhibiton, hunger) were examined with Pearson correlations. Results of this study indicate significant (p = < .05) differences between males and females in PSS and all three negative SCS subscales. There was a strong and consistent correlation between the eating behavior of disinhibition and all three negative constructs of self-compassion (self-judgment, r = .29; isolation, r = .23; over-identification, r = .28) in females. The eating behavior of restraint was similarly correlated with SCS self-judgment in females (r = .26). More research is needed to understand differences in stress, self-compassion, and eating behaviors between males and females and to better comprehend the weak associations between eating behaviors and the positive psychological constructs of self-compassion (self-kindness, common humanity, and mindfulness) for males and females. Additionally, future research should focus on the three subscales of disinhibition as they relate to the negative constructs of self-compassion. The preliminary results of this study suggest it would be beneficial, particularly to female college freshmen, to more fully understand the dynamics of the relationship between eating behaviors and self-compassion; this knowledge may help to better structure appropriate coping strategies for the prevention of disordered eating behaviors. / Dissertation/Thesis / M.S. Exercise and Wellness 2013

abstract: In an effort to understand and improve interactions between homeless young adults and the nonprofit organizations that serve them, I engaged in a long-term, qualitative, participatory action project. My project involved input from homeless young adults, nonprofit organizations, volunteers/staff, and communication scholarship. While taking a community-engaged, participatory, and qualitative approach, I focused on the interactions between youth and the organizations. Particularly, I drew on homeless young adult experiences to inform services and illuminate compassion within the context of the nonprofit organizations. In the end, this project extends the individual model of compassion to include presence, identifies potential ruptures in the process of compassion, and models compassionate dynamics in organizations. It also articulates a method I call pragmatic fieldwork, a qualitative and pragmatic approach to participatory action research. Each of these outcomes speaks to varied community interests, from theoretically nuancing scholarly models of compassion to informing policy in the interest of more effectively and compassionately serving homeless youth. / Dissertation/Thesis / Ph.D. Communication 2013

[pt] A presente tese traz como título: Mística e Compaixão: A Teologia do Seguimento de Jesus em Thomas Merton. Ela aborda a teologia espiritual de um dos maiores místicos do século XX, que fez a síntese harmônica entre espiritualidade e solidariedade, contemplação e ação. Sua mística é apresentada aqui como o encontro existencial com o mistério sublime de Deus, da criação e do ser humano. No encontro com esse tríplice mistério (mística), o ser humano se constitui como tal e sem ele a vida perde profundidade e transparência. Pois ainda hoje, em plena era espacial, ecológica e nuclear, o centro do universo continua a ser o coração humano, feito para o Transcendente. O mistério da criação consiste no fato de ela ter o ser e a vida a partir de Outro, ex nihilo, que não Se comporta como usuário ou proprietário, apesar de ver que tudo é bom e belo. Um tal amor infinito, respeitador da alteridade, ocultando-se e se tornando invisível para deixar suas criaturas ser, é paradigmático para nós hoje e inspira o cuidado responsável por todas as formas de vida, humanas e não-humanas. Destarte, a mística mertoniana apresenta um duplo movimento, a saber ascendente: de abertura para Deus e descendente: de abertura ao mundo (na metáfora includente da compaixão), que consiste no empenho por promover a paz, a justiça e cuidado responsável pela criação/ecologia. E pelo fato de a teologia do seguimento de Jesus em Merton ter profundas bases bíblicas, interpretadas numa dimensão libertadora, ecumênica e macroecumênica, ela é capaz de embasar a espiritualidade da libertação latinoamericana: Uma espiritualidade de resistência profética diante das forças desumanizadoras e opressoras do mundo globalizado excludente; uma espiritualidade da solidariedade, que se coloca ao lado das vítimas em seu sofrimento e se engaja na utopia de minimizar a fome e miséria no mundo, até se tornar topia; e, finalmente uma espiritualidade da criação, morada de Deus e do humano. Destarte, nosso objetivo será mostrar que Merton é de fato um dos precursores da espiritualidade da paz na América do Norte, e da teologia da libertação latino-americana. / [en] The theme of this thesis is: Mysticism and Compassion: The theology of following of Jesus according to Thomas Merton. It focuses on the spiritual theology of one of the best known mystics of the 20th century, who made a harmonic synthesis between spirituality and solidarity, contemplation and action. His mysticism is presented here as the existential encounter between the sublime mystery of God, of creation and of the human being. In the encounter with this threefold mystery (mysticism), the human being constitutes herself and without it life loses its deepness and tranparency. Even today, when we live in a spacial, ecological and nuclear era, the center of the universe still continues to be the human heart, made for the Transcendent. The mystery of creation consists in having its being from Another one, ex nihilo, Who does not behave as user or owner, in spite of seeing that everything is good and beautiful. Such an infinite love, respecting variety, hiding Herself and becoming Invisible in order to let Her creatures be, is paradigmatic for us nowadays, and inspires a responsible care for all forms of life, both human and non-humans. Mertonian mysticism has a double movement, namely: ascendent: opening toward God and descendent: opening to the world (compassion), who endeavors to promote peace, justice and the responsible care for creation/ecology. So, his spirituality of following of Jesus is able to embrace the Latin American spirituality of liberation: a spirituality of prophetic resistance against the dehumanizing, oppressive and excluding causes of Globalization; a spirituality of solidarity, that shares the suffering of its victims and the utopia of minimizing hunger and misery in the world, till it becomes topia; and, finally, a spirituality of creation. So, our argument is to prove that Merton is the forerunner of the spirituality of peace, feminism and macroecumenism in North America; and the forerunner of theology and the spirituality of liberation in Latin America.

Purpose: To describe an educational workshop delivered to travel nurses, with analysis of the shared discussion. Background: Travel nurses work beyond the realm of traditional nursing positions as they typically are contracted for short periods of time, fill positions created by nursing shortages, and are willing to work in various capacities. As currently conceptualized, compassion fatigue is comprised of compassion satisfaction, burnout, and secondary traumatic stress. Travel nurses are at risk for compassion fatigue as they often work on high acuity units such as emergency room and ICU. Additionally, travel nurses lack natural support systems as they often work far from usual supports such as family, which may increase the risk of compassion fatigue. Method: A two-part educational workshop was developed to reduce the risk of compassion fatigue among travel nurses (N=3). Workshops included education and skills training. Participants discussed their experiences, symptoms, and strategies they used to cope with the negative constructs of compassion fatigue. They journaled and make notations of personal and professional experiences including symptoms, triggers, and self-reflection of compassion fatigue and skills learned. Findings: Commonalities included symptoms of fatigue, isolation, disassociation, second-hand grief, physical pain, dysfunctional communication, and questioning role as a nurse. Triggers to compassion fatigue included limited resources, patient complexity, length of shift, patient influences such as gratitude for nursing service, and witnessing loss. Outcomes included self-medicating with alcohol, self-isolating, working extra shifts, and not debriefing with clinical professionals. Implications: Travel nurses experience symptoms of compassion fatigue including burnout and secondary traumatic stress that is consistent with other nursing professionals. The participants did not understand the phenomenon and had no knowledge of how to protect against compassion fatigue. Travel nurses would benefit from incorporating skills and strategies to address the phenomenon of compassion fatigue, burnout and secondary traumatic stress. The data from this educational intervention project magnify the knowledge currently known about the impact and experience of compassion fatigue in nursing populations, specifically travel nurse populations. It provides insight into the possible benefit of focus group discussions and self-care strategies in lessening the impact of compassion fatigue in travel nurse populations.

Vårdvetenskap är en autonom och professionsneutral vetenskap. Relationen mellan sjuksköterska och patient beskrivs som kärnan i vårdandet. Utan relationen blir vårdandet endast ett utförande av olika tekniska arbetsuppgifter. Ett etiskt vårdande handlar om att sätta patienten i centrum. Många sjuksköterskor hävdar att det inte finns tid till omvårdnadsarbete inom vårdsektorn och det föreligger en risk att omvårdnadsarbetet bortprioriteras när annan vetenskap värderas högre. När vårdresurser inte räcker till för att bemöta vårdbehovet uppstår hög arbetsbelastning. Hög arbetsbelastning leder i sin tur till kognitiv belastning och stress. Vård- och omsorgspersonal står för störst antal sjukfall i Sverige. Studier visar att samvetsstress är en faktor till utbrändhet hos vårdpersonal. Samvetsstress beskrivs som en unik form av utmattningssyndrom som drabbar människor i vårdande yrken och innebär en förlust av förmågan att vårda. Syftet med denna litteraturstudie är att kartlägga befintlig forskning om samvetsstress i det patientnära vårdandet ur ett sjuksköterskeperspektiv. Metoden bygger på kvantitativa och kvalitativa studier. I resultatet presenteras tre teman Bakomliggande faktorer, Symtom, tecken och konsekvenser och Åtgärdande insatser och förhållningssätt. Olika organisatoriska faktorer såsom brist på personal och tid var bidragande faktorer. Även hög arbetsbelastning, maktlöshet, samt ohanterliga krav från chefer, ledning, arbetskollegor och andra professioner gav upphov till samvetsstress. Att inte kunna lindra patientens lidande och att inte ha kunskap om samvetsstress var andra bidragande faktorer. Samvetsstress skapade psykiska och fysiska problem hos sjuksköterskan som påverkade privatlivet. Dessutom påverkades sjuksköterskeprofessionen då konsekvenserna av samvetsstress kunde leda till att sjuksköterskor valde att byta arbetsuppgifter eller lämna yrket. Studien belyser dessutom olika hanteringsstrategier som kan minska eller förhindra uppkomsten av samvetsstress. Slutligen presenteras förslag på kliniska implikationer, bland annat att undervisning om samvetsstress ska läggas in i Sjuksköterskeutbildningens läroplan samt att öka möjligheterna till Specialistutbildning.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / First of all, the following dissertation consists in a reconstruction and analysis of the major theoretical assumptions that led Schopenhauer to assert that human actions with moral value are only those derived from compassion for others. These assumptions are derived from his metaphysics of the will, a model of metaphysical characterization of the world and the human beings where the will assumes a key place, unseating optimistic visions of the human condition that conceptualizes the man as having power and autonomy. Against traditional ethical thought that believes that we act on our free will, Schopenhauer argues that we act according to our character and that is not built by our decisions throughout our lives, but it is simply revealed by them. The metaphysics of the Will, the present determinism in the doctrine of character and selfishness that rules the world as representation, arising from the principle of individuation, represent fundamental assumptions for the understanding of Schopenhauer's ethics developed in his major works on this topic: The World as Will and Representation and On the Basis of Morality. In second place, we present the main criticisms that Schopenhauer launches to Kantian ethics: first to the excessive Kantian formalism that separates morality from the actual experience of human beings, which, according to Schopenhauer, is precisely from where ethics should start. Subsequently, we will present Schopenhauer's criticism to the categorical imperative as an a priori law that imposes itself unconditionally. We will argue, thirdly, that from the metaphysical assumptions and criticisms against Kant, Schopenhauer comes to his own conception of compassion as the foundation of morals, where he will properly deal with the problem of explaining how an action is possible with genuine moral value amid the selfishness and one's incessant self-affirmation, which features our ordinary condition. Schopenhauer's answer consists, essentially, to say that the compassion is a kind of action entirely selfless, dedicated to the well-being of others. For these characteristics, compassion, as conceived by Schopenhauer, can not be taken as a simple human feeling, such as anger or joy, but its semantic core is defined as a closer model to an attitude of sympathy (a way of 'seeing the world in a correct perspective'), whose precise meaning can only be grasped from his metaphysics of the Will. Compassionate action involves a state of identification with the other, i. e., from the recognition of the unity of the Will, I am being able to identify that the suffering of others has the same configuration as my own suffering. Lastly, in the last chapter, we will present some criticisms and defenses of the proposed moral reasoning developed by Schopenhauer. A good portion of the criticism takes the assumption that compassion is a simple and foundational sense of morality. Against the criticism, for instance, our main argument is that the doctrine of Schopenhauer is not a kind of pure sentimentalism, but that compassion is more like a broader emotional attitude. We also aim to further analyze the latest perspectives for a moral theory centered on compassion from the analysis of Lawrence Blum's approach. From this analysis, we will see that,despite severe criticism, the path firstly opened by Schopenhauer has offered fruitful directions for contemporary moral-philosophical based reflections. / A presente dissertação consiste, em primeiro lugar, numa reconstrução e análise dos principais pressupostos teóricos que conduziram Schopenhauer a afirmar que as ações humanas com valor moral são somente aquelas derivadas da compaixão pelos outros. Esses pressupostos são derivados de sua metafísica da vontade, um modelo de caracterização metafísica do mundo e dos seres humanos onde a vontade assume um lugar fundamental, destituindo visões otimistas da condição humana, que apresentam o homem como dotado de poder e autonomia. Contra o pensamento ético tradicional que considera que agimos segundo nosso livre arbítrio, Schopenhauer sustenta que agimos de acordo com nosso caráter e que esse não é construído por nossas decisões ao longo de nossas vidas, mas simplesmente revelado por elas. A metafísica da Vontade, o determinismo presente na doutrina do caráter, bem como o egoísmo que rege o mundo como representação, decorrente do princípio de individuação, representam pressupostos fundamentais para a compreensão da ética schopenhaueriana desenvolvidas em suas principais obras sobre a temática: O mundo como Vontade e Representação e em Sobre o fundamento da Moral. Em segundo lugar, apresentamos as principais críticas que Schopenhauer lança à ética kantiana: primeiramente ao excessivo formalismo kantiano, que separa a moralidade da experiência real de seres humanos, que, segundo Schopenhauer é justamente de onde a ética deveria partir. Posteriormente, apresentaremos a crítica de Schopenhauer ao imperativo categórico como uma lei a priori que se impõe incondicionalmente. Argumentaremos, em terceiro lugar, que a partir dos pressupostos metafísicos e das críticas a Kant, Schopenhauer chega a sua própria concepção da compaixão como fundamento da moral, aonde irá propriamente lidar com o problema de explicar como é possível uma ação com valor moral genuíno em meio ao egoísmo e incessante afirmação de si, que caracteriza nossa condição ordinária. A resposta de Schopenhauer consiste, essencialmente, em dizer que a compaixão é um tipo de ação inteiramente altruísta, voltada para o bem-estar do outro. Por essas características, a compaixão, tal como concebida por Schopenhauer, não pode ser tomada como um sentimento humano simples, como, por exemplo, a raiva ou alegria, mas seu núcleo semântico é definido a partir de um modelo mais próximo de uma atitude de compadecimento (um modo de vero mundo na perspectiva correta ), cujo sentido preciso somente pode ser apreendido a partir da sua metafísica da Vontade. A ação compassiva envolve um estado de identificação com o outro, isto é, a partir do reconhecimento da unidade da Vontade, eu sou capaz de indentificar que o sofrimento do outro possui a mesma configuração que o meu próprio sofrimento. Por fim, no último capítulo, apresentaremos algumas críticas e defesas da proposta de fundamentação moral desenvolvida por Schopenhauer. Boa parte das críticas assume o pressuposto que a compaixão é um sentimento simples e fundante da moralidade. Contra as críticas, nosso principal argumento é que a doutrina de Schopenhauer não é um tipo de sentimentalismo puro, mas que a compaixão é mais uma atitude emocional ampla. Procuramos, ainda, analisar as perspectivas recentes para uma teoria moral centrada na compaixão a partir da análise da abordagem de Lawrence Blum. A partir dessa análise veremos que, apesar das severas críticas, o caminho aberto primeiramente por Schopenhauer tem oferecido direcionamentos fecundos para a reflexão filosófico-moral contemporânea.

The aim of this thesis was to explore the relationships between the constructs of self-compassion (SC), self-esteem (SE) and recovery in psychosis. It is presented to the reader as three separate papers. 1) A systematic literature review exploring the relationships between SE and the positive symptoms of psychosis, 2) an empirical study investigating SC, SE, recovery in psychosis and positive psychotic symptoms and 3) a critical appraisal and personal reflection of the processes involved in conducting the research. Paper one presents a systematic review of the existing literature that explores the relationships between SE and the positive symptoms of psychosis. Thirty-four articles were identified which met the strict criteria. The evidence was mixed and much of it inconclusive. There was some support for the relationship between SE and delusions, in particular paranoia. The evidence for hallucinations was much less conclusive. Recommendations for future research were suggested as were potential clinical implications which arose from the review. The empirical study presented in paper two explores the relationships between SE, SC and recovery in psychosis, and aimed to assess whether SC was a unique predictor of recovery in psychosis, over and above the impact of SE (using cross-sectional and longitudinal analysis). Further exploratory analysis was conducted to ascertain whether specific positive symptoms of psychosis were related to SC and SE. At baseline, the results indicated that SC did not contribute unique variance in recovery from psychosis over and above that attributable to SE. Longitudinally, SC at baseline was not related to recovery at follow up. Exploratory analysis revealed levels of SE and SC were significantly different in groups who had a presence or absence hallucinations, but not delusions. Methodological strengths and limitations, clinical implications and ideas for future research discussed. Paper three provides the reader with a critical reflection of the processes involved in the undertaking of the two papers presented. Implications for clinical practice are discussed as well as directions for future research.

Research has shown that a self-compassion meditation exercise in healthy individuals reduced negative affect, negative cognitions about the self and sympathetic arousal and also enhanced positive emotions and parasympathetic activity (Kirschner, Karl, & Kuyken, 2013). Beneficial effects of self-compassion, i.e., being kind and considerate to one’s self with the acknowledgement that pain cannot always be fixed or solved (Neff, 2003; Gilbert, 2009), for mental health and well-being have been previously demonstrated. This research tested the hypothesis that meditation can also be beneficial for individuals who survived psychological trauma and have post-traumatic stress disorder (PTSD), a disorder characterised by elevated physiological arousal and negative post-traumatic cognitions about the self. This study used self-report and physiological measures such as Heart-Rate (HR), Heart-Rate Variability (HRV), and Skin Conductance Level (SCL) in a trauma-exposed sample (N =56) with and without PTSD. It was revealed that both groups show significant meditation-induced reductions in state self-criticism and sympathetic arousal (HR, SCL). However, the study only found the expected pattern of significantly elevated state self-compassion and parasympathetic activation (HRV) induced by a self-compassion meditation in the non-PTSD group. This suggests that, interpreting these findings within Gilbert’s three affect regulatory systems, a single self-compassion meditation was sufficient to reduce threat in all trauma survivors and to activate the safety system in the non-PTSD group but not to initiate safety and connectedness in PTSD patients.

D.Litt et Phil. / The main objective of this study was to investigate the effect of a contemplation meditation intervention aimed at developing great compassion on the psychological well-being of a group of adolescents. A supporting aim of this study was to elucidate conceptualisations of psychological well-being and contemplation meditation (Mahayana Buddhist analytical meditation and placement meditation) theory. The subjects of happiness and well-being have been focused upon in the East for thousands of years in philosophical theorisation and methodology (e.g. Buddhism) (Gyatso, 1995, 2000, 2001a, 2002a, 2005, 2007, 2010). In the West, although comparatively lagging behind, there has been increased interest in these topics since the advent of positive psychology (Compton, 2005; Peterson & Seligman, 2004; Ryff & Singer, 2008). In the past two decades, Eastern wisdom has also become more incorporated into Western psychology. For example, mindfulness meditation has been extensively integrated into Western stress reduction and clinical therapies (e.g. Kabat-Zinn, 1982, 2003, 2009; Schroevers & Brandsma, 2010). Less is known, however, about other forms of meditation, particularly contemplation meditation. Specifically, Mahayana Buddhist theory explains that contemplation and meditation on compassion and wisdom leads to permanent inner peace and optimal happiness, which has largely been overlooked in psychology. Furthermore, regarding Western positive mental health interventions, there is still limited research on how to foster well-being specifically in adolescents. Moreover, Huebner and Diener (2008) have noted that subjective well-being research in adults exceeds subjective well-being research in youth. Additionally, there is minimal research on psychological well-being as understood from the eudaimonic perspective, in comparison to hedonic subjective well-being (Keyes, 2009). The present study thus attempts to expand knowledge on increasing psychological well-being in adolescents by also drawing on Eastern theorisation and methodology.