Background: Providing care to individuals with multifaceted mental health needs can be very demanding and in turn leave mental health professionals at an increased risk for compassion fatigue (CF). Comprised of Burnout (BO), Secondary Traumatic Stress (STS), and a lack of Compassion Satisfaction (CS), CF is the state of exhaustion and dysfunction, emotionally, biologically, and physiologically, due to prolonged exposure to compassion stress. CF can leave healthcare providers at an increased risk for experiencing their own health issues, contributing to tardiness and absenteeism, as well as increasing the risks for such adverse effects as clinical and medication errors, poor treatment planning, and decreased patient satisfaction. Purpose: The purpose of this paper is to identify the risk factors for CF and describe the perceptions of CF among outpatient mental health providers employed in urban community-based mental health outpatient organization. Method and Sampling: A qualitative descriptive study design utilizing two focus groups, each having four participants was conducted to assess outpatient mental health providers’perceptions of CF. Purposeful sampling of current providers in two community-based mental health outpatient organizations was performed to protect the privacy and enhance the comfort of each participant as they discussed elements of CF. Findings: Five themes were identified from the focus group analysis: the participant’s perceived definition of CF, participant perceptions of prevalence of CF in the mental health setting, participant perceptions regarding the triggers, perceived participant causes of CF, and self-care practices. These results reflect data collected in a mental health setting however, the findings are consistent with current research contributed from other specialties. Conclusion: Personal descriptions of the experiences and insights of these providers expand the current CF literature and will contribute to the development of quality improvement projects committed to reducing compassion fatigue among outpatient mental health providers.

The purpose of this study was to describe the experiences, symptoms, and effects of compassion fatigue among emergency nurses, and to identify potentially effective interventions. Compassion fatigue within the profession of nursing is of growing concern due to its negative impact on nurses' mental and physical health, productivity, and patient care. There is a notable paucity of available qualitative research related to compassion fatigue in nursing, but available quantitative data indicates that emergency nurses could be especially at risk for developing compassion fatigue. Compassion fatigue is commonly conceptualized as being composed of burnout and secondary traumatic stress; however, previous exploratory research indicated that this definition might not adequately fit emergency nurses. Focus group interviews were conducted with emergency department nurses from four local hospitals. The participants were asked about their experiences, symptoms, and perceptions of the effects of compassion fatigue, and about potentially effective interventions to address compassion fatigue within their work setting. A content analysis of the interview data was performed to identify categories, common threads and patterns, and related themes. Although the participants' average length of time working in the emergency setting was less than two years, they all reported having intense experiences related to professional burnout, secondary traumatic stress, and the negative effects of compassion fatigue. The development of compassion fatigue was contributed to both organizational (time pressure and lack of resources and leadership support) and patient (clinical uncertainty, reason for seeing care, and witnessing grief) factors. The main symptoms of compassion fatigue were exhaustion, impaired communication, decreased emotional tolerance, coping with dark humor, and detachment/dissociation. These symptoms affected the participants both at work and home. The suggested potential interventions comprised of self-care activities, debriefing with clinical staff, continuing education, and increasing awareness about compassion fatigue in the work setting. The data from this qualitative descriptive study expands our knowledge of the concept and ramifications of compassion fatigue in nursing, specifically in the emergency setting. It also offers potentially effective interventions to prevent and address the negative effects of compassion fatigue.

Human immunodeficiency virus (HIV) can result in posttraumatic stress disorder (PTSD) as events related to illness act as traumatic stressors. This study tested some basic hypotheses of Sewell and Cromwell's personal construct model of PTSD in HIV+ women both with and without diagnoses of PTSD. Trauma-related constructs of HIV+ women with PTSD with HIV+ non-PTSD controls at varying stages of illness were compared. The elaboration, rankings, and valence of trauma-related constructs were examined using the Life Events Repertory Grid (LERG) procedure. Findings provided evidence that a clinical diagnosis of PTSD in women was not associated with the degree of construct elaboration. These findings may imply a qualitative difference in cognitive processing of social stressors and violent stressors.

Prior research has identified risk factors that may contribute to the development of maternal stress reactions following childbirth. Specifically, situational factors (e.g., factors associated with childbirth), individual factors, and personality factors, have been explored in a multitude of prior studies. The current study sought to build upon this literature by examining both risk and resilience in a sample of both mothers and fathers via a prospective longitudinal investigation. Baseline assessment of expectant parents occurred prior to the birth of their child, with additional assessment at approximately 1, 6, and 9 weeks post-childbirth. A total of 50 participants completed all four of these assessments. Results indicated approximately 20% (n = 10) of participants endorsed moderate or greater stress symptoms after birth, while 22% (n = 11) also exhibited symptoms of moderate or greater depressive symptoms. Stress reactions were assessed with the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ); validity analyses indicated the PPQ had significantly stronger correlations with convergent measures than discriminant measures. Additionally, participants were randomized into one of two post-delivery study arms: an expressive writing group or an active control group. Although expressive writing results were inconclusive, there was a general effect of time, which may be reflective of a natural recovery process. Given the prevalence of stress and depressive reactions in this sample, and the population, exploration into feasible and accessible treatment interventions is warranted. While these results also suggest a potential natural recovery for some participants, interventions for support in the short-term timeframe after childbirth may continue to be useful.

Current military operational environments are highly improvised and constantly evolving, threatening the lives of U.S. warfighters. For instance, since 2001, 60% of all hostile casualties and 65% of hostile injuries in the Middle East theater have been attributed to improvised explosive devices (IEDs). IEDs are powerful physical weapons, and the stressful atmosphere they, and other operational challenges create, can also result in a range of psychological dysfunctions, including anxiety, depression, alcohol abuse, and Post-Traumatic Stress Disorder (PTSD). Not only are these issues concerning for mental health reasons, they are also problematic in terms of combat performance. Extreme arousal (i.e., stress) negatively affects performance through the suppression of cognitive and physiological resources, which inhibits verbal, perceptual, and motor performance. Perceptual abilities are particularly susceptible to the effects of acute hyperarousal, and the degradation of these abilities may limit warfighters’ threat detection skills. Therefore, military researchers are interested in whether and how the visual perceptual field is changed under stress, and the Services are making predeployment training programs a priority, in an attempt to mitigate these concerns. This dissertation first outlines the cognitive processes related to visual perceptual abilities and how these processes are negatively affected by acute arousal. Current training programs in perceptual skills and stress tolerance are then described, along with recommendations for areas of improvement within the status quo. Based on these recommendations, an experimental procedure and five hypotheses were designed to assess training effects on visual perceptual skills and performance under stress. Experimental outcomes suggest that participants who were trained using a novel integrated perceptual skills plus stress resilience (“perceptual resilience”) program performed faster and with higher accuracy during a stressful threat detection task than participants trained using a perceptual skills-only program and participants trained using an existing status-quo knowledge trainer. Participants in this perceptual resilience training group also reported lower feelings of acute stress and anxiety immediately post-task than the two other training groups who did not receive the stress resilience training component. Based on these outcomes, implications for future military-specific training development, study limitations, and recommendations for future research is presented.

Background Post Traumatic Stress Disorder (PTSD) is a psychiatric debilitating condition that can occur in individuals who experience extremely stressful or traumatic life events. Sexual assault is considered as one of the most traumatic stressor in life. Although few studies investigated the association between history of sexual assault and PTSD, no studies have examined the impact of age at sexual assault on PTSD.Method A cross-sectional telephone survey was conducted among adult female residents of Virginia from November 2002 to February 2003. A total of 1,769 women aged 18 and older were interviewed using a random digit dialing method. Detailed screening questionnaire was utilized to ascertain the occurrence of sexual assault, age at sexual assault and PTSD. The DSM-IV diagnostic criteria were used to define PTSD.Result The prevalence of PTSD among women with no history of sexual assault, those victimized before the age of 18 and 18 and above was 8.1%, 35.3%, and 30.2% respectively. Multivariate logistic regression model showed an increase risk of PTSD among women assaulted at a younger age. Compared to women with no history of sexual assault, women who were victimized before their 18th birthday were 2.8 times more likely to suffer from PTSD [OR=2.78 (95% C1=1.87- 4.23)]. The risk of PTSD among women victimized as adults was 2.6 times higher compared to women with no history of sexual assault [OR=2.59 (95%CI =1.43-4.70)].Conclusion This study provided important information on the association between PTSD and age at sexual assault. The risk of PTSD is relatively higher among those assaulted before the age of 18. The adverse effect of sexual assault as a risk for PTSD in addition to other negative health problems is a major public health concern. Primary prevention strategies should be in place to detect sexual assault victims and prevent the occurrence of PTSD.

Abstract This quasi-experimental design study compared two small samples of Emergency medicine residents after one group had an educational intervention on death notification skills and the other did not. Comparisons were made on residents’ confidence in their communication, interpersonal skills and level of compassion fatigue/satisfaction and EM Residents’ level of Secondary Traumatic Stress after an event of patient death and subsequent notification of Secondary Patients. Residents were interviewed to gather recommendations for designing death notification curriculum. Over an eight month period, forty emergency medicine residents at two sites, control and intervention, completed surveys designed to provide quantitative data on self-confidence and stress related to recent patient deaths. Residents who participated in a death notification event completed the Secondary Traumatic Stress Scale. Interviews were conducted to gather information on the impact of the notification and recommend changes in curriculum at the experimental site. The data infer that an educational intervention on death notification skills increased residents’ confidence in their ability to give compassionate death notification to families as compared with the control group. Residents in the intervention and control group had no significant differences in their potential for compassion satisfaction. Residents who had the educational intervention showed less Secondary Traumatic Stress symptoms than their non-intervention counterparts. The intervention group showed less risk for burnout (although it would only be significant at p < 0.10). The overall conclusion is that there is some evidence for a positive effect of the intervention. However, due to the small sample size the conclusion is tentative and more research is needed to evaluate the training.

D.Litt. et Phil. / The negative psychological effect of rape on survivors has been extensively researched, with most studies emphasising rape-related Post Traumatic Stress Disorder (PTSD) its symptoms, diagnosis and treatment. Interventions described in the current literature mainly aim at measuring and reducing symptoms, and restoring functioning in rape survivors. Group art therapy has been used with adult and adolescent survivors of incest with encouraging results, but little research has been published regarding its use with rape survivors. My intention in the current study is to examine the utility of a group art therapy intervention with adult female rape survivors in a South African context. I selected a postmodern feminist theoretical basis for the study, and examined the societal discourses that promote women’s disadvantaged status and high levels of rape in South Africa. I used qualitative methods to analyse the art works, journals and transcripts produced by three participants during seven weekly group art therapy sessions. I used postmodern feminist research methods, such as participant observation, reflexivity, and concepts such as situatedness, bodiliness, relatedness and plurality of explanations to assess the women’s lived experience of rape, their recovery from it, and the intervention itself. The current study proposes that analysing the data reveals metaphors, symbols and meanings that represent the lived experience of the women participants in the group art therapy intervention. I used a grounded theory approach to data analysis, as well as methods from content analysis, visual anthropology, iconography, social semiotics and visual cultural studies in order to assist with triangulation of the visual and verbal data. The data was voluminous and rich, and fourteen strands of meaning emerged from the data, consisting of vivid metaphors, visual and verbal symbolic language, and insights into the challenges and victories of each of the participants. I gathered these strands under two overarching themes: one of themes related to the rape, and the other related to the group art therapy experience. I conclude that group art therapy was useful to the participants, and that the data analysis gave considerable insight into the individual nature of recovery from rape, such as coping mechanisms, influence of personality on recovery, the dialectical nature of recovery and the difficulty of recovering from a trauma that affects every area of functioning. The current study provides a structured format for clinicians interested in group art therapy, and I have provided suggestions for those who wish to replicate the intervention. My findings propose that the intervention was a powerful therapeutic tool for the participants, and that it provides a structured short-term group outline for use with the vast numbers of rape survivors in South Africa.

D. Ed. / Trauma can be described as the emotional shock response to a physical or emotional injury that is overwhelming and has a lasting effect on a person. Based on this definition, trauma can be considered an integral part of life in South Africa. The consequences and effects of trauma are severe, both on individual and society levels. Nobody escapes the effects of trauma, but women and children are particularly vulnerable. Unfortunately the vast majority of South Africans have little or no access to mental health services. Some people, however, seem to be resilient in response to trauma and hardship. Although various definitions of resilience can be found in the literature, resilience is defined in this thesis as the ability and characteristics that enable a person to endure, recover from, and be strengthened to grow personally, regardless of exposure to traumatic life events. Women are generally the primary educators of children in the South African society, whether it be their own children, grandchildren or others. If South African women were equipped with skills that could enable them to deal more effectively with trauma, they would – as primary educators – naturally transfer their skills and knowledge to the children in their care. There exists a need for preventative interventions that may equip women to cope effectively with trauma. Certain educational interventions may provide avenues through which this may be achieved. Educational drama is one such avenue through which women of diverse educational, socio-economical, and cultural backgrounds may be reached in a comprehensible, accessible and non-discriminatory way. In this study a number of issues pertaining to the prevalence of resilience in South African women have been explored and described. The purpose of this study was to create an interactive educational play aimed at facilitating mental health in women exposed to traumatic life events.

M.Cur.