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Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument to assess existential distress in patients with cancer and other severe medical illness. The purpose of this study was to provide normative values derived from a representative German general population sample and to analyze the correlational structure of the DS-I. Methods: A representative sample of the adult German general population completed the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety, depression, anger, need for help, and the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-fatigue). Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18–94 years), 55.7% women). The percentages of participants above the DS-I cutoff (30) was 13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3) dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I reliability was excellent (a = 0.94) and DS-I subscales were interrelated (r between 0.31 and 0.87) and significantly correlated with ET, especially depression, anxiety, and need for help and fatigue (r between 0.14 and 0.69). Conclusions: In order to use the DS-I as a screening tool in clinical practice and research the normative values are essential for comparing the symptom burden of groups of patients within the health care system to the general population. Age and sex differences between groups of patients can be accounted for using the presented normative scores of the DS-I.

Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale- II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer. Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach‘s Alpha (a). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatmentrelated variables were examined with ANOVAs. Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with a = 0.93 for the DS-II total scale, a = 0.90 for the Meaning and Purpose subscale, and a = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60). Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.

The COVID-19 pandemic has immeasurably impacted nearly every aspect of schools from day-to-day operating procedures to the way students attend classes to curricular and instructional matters. In the early stages of the pandemic, while COVID-19 spread across the country, the large-scale, nationwide closure of schools in March 2020 forced educators, students, and families alike to adjust to emergency remote teaching with virtually no warning or preparation (Marshall et al., 2020; Hodges et al., 2020). As the 2019–2020 school year came to a close remotely, states began the process of reopening after initial COVID-19 related closures; and the predicament of how to reopen schools in the fall became a major topic of debate. This contentious debate continued throughout the rest of the 2020–2021 school year as school buildings went in and out of in-person, hybrid and remote instructional models; and the public health crisis persisted. Caught squarely in the crossfire of the debate and on the receiving end of policy coming down from state governance were public-school classroom teachers. Historically, this top-down dynamic is certainly not new for the teaching profession (Lortie, 1975; Cohn et al., 1993; Gratch, 2000). Intersecting with this reality is the view of teachers as executors of policy that others create (Cohn et al., 1993; Cochran-Smith et al., 2009) — a view that situates teachers in a web of bureaucracy (Elvira, 2020) that is often at odds with their expertise and local knowledge of practice (Cochran-Smith et al., 2009). This view ultimately results in the exclusion of teachers’ voices in decision-making arenas (Cohn et al., 1993). While preliminary research investigating the impacts of COVID-19 on teachers and the teaching profession has established some of the emotional and physical toll that has occurred, more details with respect to the way that teachers experienced the work of teaching itself in conjunction with policy decisions is necessary. The three studies in this dissertation address these needs by teasing out teachers’ perspectives, challenging the lingering image of teachers as technicians and the status quo of top-down policy enactment, and determining a way to move forward. More specifically, these studies occur within the context of public-school teaching in the state of Massachusetts (MA) and involve data sources that include survey responses from full-time, public-school teachers in MA who actively taught in the 2020–2021 school year as well as policy memos that came from the MA state educational agency (SEA). The combination of articles in this dissertation examines topics including the status of teachers’ voices and influence in decision-making forums, the relationship between policy and teachers’ work, teachers as experts versus technicians, and teacher demoralization throughout the pandemic. By drawing upon teacher survey data from 122 full-time, public-school teachers in MA, the first study captures their experiences teaching during the pandemic from the onset of the pandemic in March 2020 through April of the 2020–2021 school year. This first study provides a window into the direct experiences teachers had teaching during the pandemic in comparison to teaching prior to the pandemic and sets the groundwork to show how teachers’ experiences do not align with images of teaching as put forth by the MA SEA and the policy rolled out during the pandemic. The second study uses document analysis to examine policy artifacts produced by state governance in the wake of COVID-19 and the way they communicate certain perceptions of teachers and the work of teaching. The third study returns to teacher responses to inquire about their perceptions of the state educational agency’s level of support and policy developed during the pandemic. As such, this third study demonstrates the teacher demoralization that results from the lack of inclusion of teachers’ voices in decision-making forums and the disconnect between policy and teachers’ work during the COVID-19 pandemic. Together these studies reflect that the COVID-19 pandemic has further underscored the gap between the individuals in the classroom and those in decision-making forums. As such, it has revealed the need for a more detailed understanding of the commitments that teachers juggle at the classroom level in order to better align policy, research, and state and national responses with the daily needs of students and teachers.

<p>The Royal College of Physicians and Surgeons recognizes the role of health advocate as a central aspect of doctoring that can greatly impact the quality of care one receives. Current literature discussing physicians as health advocates is sparse, particularly in the area of medical training. This study aims to identify how medical residents negotiate between their identity as a physician, which is bound by the narrow confines of biomedicine, and a more comprehensive vision of health care that incorporates advocacy. A thematic narrative analysis of four weblogs authored by medical residents was employed to complete this study. The culture of medicine and the hidden curriculum surfaced as impediments to advocacy in residency training, resulting in residents experiencing a crisis in caring, compassion and communication. When residents were not able to care for their patients in ways that met their moral expectations of what it means to be a healer, they felt depersonalized and became disenchanted with medicine. Arthur Frank’s theory regarding the demoralization of medicine is used to illuminate the importance of dialogue within the doctor-patient relationship, as well as its impacts on health advocacy. This study explores the concept of advocacy and brings forth the question: Given what we know about medicalization and the culture of medicine, should physicians be health advocates for their patients when their training is restricted to biomedical interventions and notions of care?</p> / Master of Arts (MA)

In order to obtain a closer look into the psychosocial impact of chronic conditions, symptom severity, loss of resources, and demoralization were investigated through a mediation analysis. The function and implication of social support was also explored within the circumstances of chronic conditions. Lastly, symptom chronicity was probed as an influential element in the understanding of the consequences of being chronically ill. Participants were 200 men and women, with a mean age of 46 years, and the dataset came from the VOICE (Verification of Illness and Coping Experience) survey. The concepts of Conservation of Resources (COR) theory and Demoralization Syndrome were utilized to portray the underlying processes experienced by individuals with chronic condition. Analyses between symptom severity and demoralization via loss of resources as the mediator were statistically significant. Symptom chronicity did not interact with symptom severity on predicting loss of resources, but analyses showed that individuals with less symptom chronicity reported both larger loss of resources and demoralization. Social support was confirmed as a moderator, buffering the effects of symptom severity on loss of resources. Exploratory analyses with the inclusion of both symptom severity and chronicity as the predictor variable and the use of age as a moderating factor at the prediction of loss of resources was statistically significant, showing that when symptoms were more severe and chronic, younger participants experienced more losses than older participants. Additionally, when age was included as a moderator of the effect of symptom chronicity and severity on the prediction of social support, it was indicated that when symptoms were less chronic and severe, the average perception of social support was higher among younger participants, but, on the other hand, when symptoms were more chronic and severe, younger participants suffered an abysmal drop in their social support perception. In light of the aforementioned results, risk, protective, and developmental aspects are discussed, along with implications for health care providers.

No description available.

The purpose of this study was to develop an instrument to measure K-12 teacher demoralization. An increasing body of literature has labeled modern education policies as having a demoralizing effect on teachers (Darling-Hammond & Rustique-Forrester, 2002; Noddings, 2004; Ryan & Brown, 2005; Nichols & Berliner, 2007; Santoro, 2011; Hargreaves, Braun, & Gebhardt, 2013). Teacher demoralization has been defined as a teacher’s “inability to access the moral rewards of teaching” (Santoro, 2011, p. 3). Data was collected from a population of K-12 educators through cognitive interviews (n=6) and a large scale data collection analyzed with a principal component analysis (n=430) in an effort to determine which constructs should be included in the measurement of teacher demoralization. Feedback on the survey instrument was incorporated in an iterative process at each stage of data collection. Results revealed that the theory of teacher demoralization should include two factors: teacher dispositions and feelings of demoralization. The current study failed to find strong evidence of convergent validity with teacher burnout and self-determination need thwarting; however, results suggest that emotional exhaustion and autonomy need thwarting are moderately related to teacher demoralization. Evidence of discriminant validity in relation to teacher self-efficacy was found; however, other discriminant validity evidence was inconclusive. This study extends the literature by providing the first attempt to measure the phenomenon of teacher demoralization. Future studies should continue to refine the instrument of teacher demoralization, and can use this instrument as one way to examine the impact of policy on teachers.