Iris Fitzgerald struggles to make it day to day after she is raped and stabbed while out on an early morning run. Her story is told through her relationships, not only with her new, scared self, but also with her overbearing mother, her best friend, her rescuer and her antagonistic roommate. She has just moved to a strange city and still has not found a job. So, she has the overwhelming stress of the attack to contend with and the added pressure of running quickly out of money in the expensive city of San Francisco. She uses her painkillers as an escape from her stab wound as well as her emotional pain. Claiming Iris is about self-preservation, relationships, addiction and continuing on with life.

Purpose: Describe the meaning of compassion fatigue (CF) as experienced by the U.S. military registered nurse (RN) post-deployment from Iraq and Afghanistan. Background: CF is characterized by deep emotional and physical exhaustion, and may resemble posttraumatic stress disorder (PTSD). Often this causes a shift in confidence and clouds RN perceptions. Symptoms include difficulty concentrating, intrusive imagery, hopelessness, exhaustion, and irritability leading to profound alterations in one's view of the world, patients, family, and friends. Outcomes include depersonalizing patients, poor coping mechanisms, lowered standards, clinical errors, and blurring boundaries, all can contribute to a toxic work environment and RNs leaving the profession. Method: Hermeneutic phenomenological methodology facilitated a description of CF in words and meaning expressed by U.S. military RNs (i.e., Army, Navy). The sample was obtained through the snowball method and aided by key informants. Data were collected through interviews and observations with each active duty or reservist RN (N = 8) on three occasions. Participants described their military and nursing backgrounds and experiences of CF through hermeneutic interview. Analysis was ongoing during the interview process and included continual questioning, reflecting, and validating. This process allowed for understanding through engagement of text (e.g., dialogue, transcriptions). Journaling and self-reflection assisted with trustworthiness. Findings: Participants shared many experiences. While some had unique experiences, their feelings and perceptions resonated with other participants and informed the emergence of four shared meanings and shared concerns: (a) the term CF does not fit me, manifested by expressions of the meaning of CF; (b) compassion fatigue as all encompassing, manifested by physical, emotional, relational, and spiritual experiences; (c) compassion fatigue will not interfere with my military duty, manifested by the pervasive military lens that the meaning of the experiences are filtered, and (d) compassion fatigue affects people long after deployment . . . gone, but not forgotten, manifested by the lasting effects of CF. Implications: While CF among military RNs has many similarities with the general nursing population, the practice environment appears to create additional triggers and manifestations. This study provides an understanding of the progression of CF in this population. Implementing interventions before and after trauma exposure can preserve the care in military caregivers.

M.A. / The Truth and Reconciliation Commission (TRC) Act was passed in 1995 and the TRC started its hearings in 1996. The purpose of the TRC was to promote national unity and reconciliation by establishing as complete a picture as possible of the human rights violations that had occurred during the apartheid era and to offer reparations to those who had been affected, as well as to grant amnesty to those who had committed these human rights violations. The TRC had to appoint people to help carry out its functions and deliver a report about human rights violations. Most of the people employed by the TRC to help carry out these functions were South African. Furthermore every South African had been involved in the past in one way or another, purely by being a South African. In this project the author explores, analyses and interprets the experiences of some of the people who were employed by the TRC. The focus of this project is to find out whether being employed by the TRC and having to listen to the stories being brought to the TRC exposed anyone to the possibility of developing what is called secondary traumatisation. This kind of traumatisation is different from the traumatisation that the people relating the stories had gone through during the apartheid years. This kind of traumatisation is said to develop from being exposed to traumatised people.

The South African service (SAPS) has a reputation for being resilient despite the amounts of trauma they are exposed to. Research has shown that this occupation is one of the most stressful. However, research surrounding the SAPS suggests that police work is one of society’s most stressful occupations. The way in which individuals respond to such traumatisations is dependent on numerous factors, two being personality and coping. In so far, this study investigated three main areas around police reservists – a unit within the SAPS - in order to understand their responses to trauma: whether personality factors were related to post-traumatic stress symptomatology (PTSS) in the police reservist population; whether coping moderated the relationship between personality factors and PTSS; whether a personality factors predict coping style. A quantitative analysis was conducted among a sample of 36 reservists in the Gauteng area of South Africa. This study found that the relationship between Neuroticism and PTSS is mediated by coping, specifically Emotion-Focused and Dysfunctional Coping styles. A relationship between Conscientiousness and PTSS showed to be prevalent, however this is not due to the mediation affect of coping. Furthermore, Neuroticism and Extraversion showed to predict coping style. Specifically, Neuroticism showed to affect EFC and DC and Extraversion showed to affect EFC. The descriptive statistics showed that this sample of police reservists is suffering from PTSD. Implications of these findings are discussed and directions for future research are explored.

Thesis (M.A.(Industrial Psychology)--University of the Witwatersrand, Arts Faculty, 1996 / At a primary level the current study sought to investigate the post-traumatic stress responses of a sample of black township residents who were victims and witnesses of continuous civil violence [Abbreviated abstract. Open document to view full version]

Violent and traumatic events are a regular occurrence in many South Africans’ lives. The term 'continuous traumatic stress’ was coined by South African anti-apartheid health professionals in the 1980’s to explain the continuous nature of violence and trauma happening within the country. Although the political agenda may have shifted, many South Africans are still living within a context in which violent and traumatic events regularly occur. However, little is known about how health workers respond to continuous trauma within the South African setting. The Community Health Workers - within this study - are part of the South African health model called ‘Primary Health Care Re-engineering’ that is currently being piloted. The research was exploratory in nature and used a mixed methods design. Twenty three Community Health Workers who participated in the study were from two sub-districts within the Ekurhuleni district, Gauteng, Johannesburg. The research included two face to face semi-structured individual interviews. The first included qualitative questions and completion of the quantitative Stressful Life Events Screening Questionnaire (1998) to explore past trauma experiences. Over a seven month period, the participants were asked to document traumatic event exposure and responses through the adapted Life Events Checklist (1995) and personal journaling. At the end of this period, participants were interviewed again to explore their current traumatic experiences. Qualitative data were analysed through thematic content analysis and quantitative data were used to substantiate information from the interviews and checklists. Results show that Community Health Workers – within this study - have a high prevalence of exposure to traumatic events (directly experiencing, witnessing and hearing about). Prominent events included physical and sexual assault, transport accidents, fires and explosions. Media played a powerful role in exposure to events. Traumatic and unexpected losses were key experiences that need to be considered when working with trauma in the South African context. Acknowledgement of experiences (peer and external) is an essential element in developing support structures. These findings – from the context of Ekurhuleni, South Africa - contribute to exploring and understanding the experience of ‘continuous traumatic stress’ for Community Health Workers.

La thèse a pour objectifs d’étudier les liens entre les mécanismes de régulation émotionnelle (RE) et les psychotraumatismes de type I et II. Elle s’intéresse également aux indicateurs physiologiques caractérisant ces processus de RE et leurs éventuelles modifications dans les cas de Stress Post-Traumatique (SPT) ou d’exposition à des événements aversifs (trauma complexe). Pour cela nous avons mené trois études. La première étude s’intéresse à mettre en évidence des prédicteurs du développement d’un SPT complet ou subsyndromique, suite à un accident de la voie publique. Les résultats font apparaître que plus d’un quart des participants présente un subsyndrome traumatique ; pour 7,7% de patients avec un SPT complet. Parmi de nombreuses variables, le meilleur prédicteur est la perception d’une menace vitale. Des liens forts sont également observés entre d’une part, la détresse péritraumatique et les symptômes de reviviscence et d’hyperactivité neurovégétative, et d’autre part entre la dissociation traumatique et l’évitement. La seconde étude s’intéresse à évaluer la variabilité du rythme cardiaque (VRC) comme biomarqueur des difficultés de régulation émotionnelle (DRE) en population non-clinique. Les résultats montrent que le groupe qui a peu de DRE présente une diminution de la VRC durant une phase d’induction émotionnelle puis une augmentation jusqu’à un niveau statistiquement équivalent à sa ligne de base en phase de récupération post-induction. Cette réponse sympathoexcitatrice adaptative est modifiée dans le groupe avec beaucoup de DRE : la VRC n’augmente pas en récupération. Ces données suggèrent que la VRC est un biomarqueur pertinent des DRE. Enfin, la dernière étude cherche à évaluer l’impact d’un trauma complexe (TC) sur plusieurs processus émotionnels. Les DRE et la dissociation somatoforme discriminent le mieux les groupes d’adolescentes présentant un TC des adolescentes contrôles. De plus, les mesures physiologiques montrent que le niveau de VRC au repos est plus faible dans le groupe TC et que le pattern typique de réaction sympathoexcitatrice est absent, à la différence du groupe contrôle. Les analyses de régressions précisent que le manque de conscience émotionnelle prédit le niveau de VRC au repos alors que c’est le niveau de dépression qui prédit le mieux la diminution phasique de VRC. Ajoutée à un taux d’erreur plus important pour évaluer subjectivement les stimuli émotionnels dans le groupe TC, les événements aversifs répétés semblent perturber à la fois des processus liés à l’évaluation des signaux émotionnels et leur intensité, mais aussi les processus psychologiques et physiologiques liés à la régulation des émotions. Ces résultats qui confirment le rôle important des DRE dans les psychotraumatismes seront discutés par rapport à la littérature actuelle pour proposer des pistes thérapeutiques spécifiques. / This thesis aims to explore the links between emotion regulation (ER) mecanisms and type 1 and 2 psychotrauma. We also investigate physiological marker of those ER processes and the potential disturbances caused by Post-Traumatic Stress Disorder (PTSD) and adverse life events (complex trauma). Three studies were carried out. The first study assesses some predictors of the development of a complete or subsyndromic PTSD following a motor vehicule accident. Results reveal that more than one quarter of the sample exhibits subsyndromic PTSD and 7.7% was diagnosed with complete PTSD. Among several variables, the strongest predictor is the perceived life threat. Also, strong correlations are observed between 1) peritraumatic distress and persistent re-experiencing or hyperarousal and 2) dissociation score and avoidance strategy. The second study evaluates Heart Rate Variability (HRV) as a potential biomarker of emotion regulation difficulties (ERD) in a non-clinical population. Results for the low ERD group show that HRV decreases from baseline to elicitation and then increases from elicitation to recovery (no difference between recovery and baseline levels). This adapatative sympato-excitatory pattern is altered in the high ERD group in which HRV do not increase from elicitation to recovery. Those data suggests that HRV could be an unbiased biomarker of ERD. The last study examines the effects of complex trauma (CT) on several emotional processes. ERD and somatoform dissociation best discrimate between CT and control teenagers. Moreover, physiological measures show that HRV level at rest is lower in CT than control and typical sympato-excitatory response is not observed in CT contrary to control group. Regressions analyses further reveal that the lack of emotional awareness predicts HRV level at baseline whereas the level of depression best predicts phasic HRV decrease. Added to greater errors in the subjective assessment of emotional stimuli in the CT group, adverse life events seem to disrupt processes involved in the labelling of emotions and intensity as well as psychological and physiological processes linked to ER. These results which confirm the importance of ERD in psychotrauma are discussed in regard to contemporary literature in order to suggest some specific therapeutic approaches.

Consolidated memories can become reactivated in order to permit the integration of new information into the memory trace. Blockade of the resultant process, reconsolidation, with NMDA receptor antagonists or protein synthesis inhibition can lead to a decrease in subsequent memory expression. This may offer a potential tool for the treatment of psychiatric disorders characterised by maladaptive memories, including drug addiction and post-traumatic disorder. Given the importance of instrumental associations in supporting drug addiction experiments in Chapters 3 & 4 aimed to disrupt reconsolidation of these memories. Treatment with an NMDA receptor antagonist prior to retrieval sessions of various durations was not able to consistently prevent reconsolidation of these associations. Drug addiction is characterised by memories that have been formed not over days or weeks, but months or years. Experiments in Chapters 5 & 6 therefore investigated how the extent of training affects the propensity of an appetitive pavlovian memory to reconsolidate. Experiments in Chapter 5 were not able disrupt reconsolidation of these memories after a relatively short period of training. In Chapter 6 attempts to disrupt reconsolidation of a cocaine-seeking memory having undergone extensive training (>1 month, designed to promote the formation of drug-seeking habits) were also unsuccessful. However, when animals were trained in a similar fashion to respond for a food reinforcer treatment with a NMDA receptor antagonist prior to a reactivation session resulted in a decrease in food-seeking behaviour the following day. However, this deficit was only found in the first test session; drug treatment had no effect on responding following reminder of the memory. If data from preclinical studies are to inform future psychiatric treatments the findings from these works must be robust and replicable. Experiments in previous chapters encountered several issues in this regard, namely the repeated inability to prevent reconsolidation with NMDA receptor antagonism. Given that reconsolidation of auditory fear memories is well characterised a final series of experiments in Chapter 7 used this procedure to explore the possible reasons for the fleeting or absent effects of disrupted memory reconsolidation in previous chapters. Despite the use of similar methods as published reports showing decreases in memory expression as a result of blockade of reconsolidation it was not possible to disrupt this process with NMDA receptor antagonism or protein synthesis inhibition. Results suggested that the failure to observe reactivation-dependent amnesia was due to the amnestic agent used not being able to prevent reconsolidation, should it be taking place, and a failure of the given retrieval trial to result in memory reactivation. On numerous occasions throughout this thesis it was not possible to disrupt memory reconsolidation. One difficulty in interpreting null data of this nature is that it is often unclear whether the results are due to insufficient retrieval conditions to result in memory reconsolidation, or an inability of the pharmacological agent to disrupt this process. The final experiments of this thesis raised the possibility both of these issues may have contributed in tandem towards this inability to prevent memory reconsolidation.

I och med den utvecklade tekniska utrustningen överlever allt fler patienter som drabbats av trauma. Därför är det stor sannolikhet att vårdpersonal under sitt arbete kommer i kontakt med dessa patienter. När vårdpersonalen är i kontakt med patienter som drabbats av trauma är det många gånger omöjligt att själv bli påverkad. Detta kan leda till att vårdpersonalen själva får liknande symptom som patienten. För att undvika framtida obehag är det av överordnad betydelse att vårdpersonalen har kunskap om att omhändertagande av traumatiska patientfall på arbetsplatsen kan komma att påverka vårdpersonalens egen kropp och psyke samt hur vårdpersonalen kan lära sig uppmärksamma dessa symptom. Syftet med uppsatsen är att med hjälp av Evans (2003) metod för att analysera kvalitativa artiklar beskriva vårdpersonalens upplevelser av att utsättas för traumatiska händelser på arbetet. Resultatet består av tre huvudteman. Den första behandlar upplevelser av att vara i kaos, med underteman: upplevelser av triggers som utlöser stress, upplevelser av att känna moralisk plikt, upplevelser av övergivenhet samt upplevelser av att inte räcka till. Tema två berör att reagera på den traumatiska händelsen och behandlar att märka av somatiska och psykiska symptom, upplevelser av att bli alltför personligt involverad, upplevelser av skam och skuld samt att distansera sig. Tredje temat berör att bemästra den traumatiska händelsen och handlar om strävan att upprätthålla balans i livet. Resultatet visar att vårdpersonalens upplevelser stämde bra överens med aktuell forskning, att det finns ett stort behov av att bearbeta traumatiska händelser samt arbetsgivarens möjlighet att fånga upp vårdpersonalen innan de mår alltför dåligt. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

På många intensivvårdsavdelningar skrivs det dagbok för patienten. Dagboksskrivande på intensivvårdsavdelning är dokumentation av vårdtiden skrivet till patienten av sjuksköterskor och annan vårdpersonal och i vissa fall närstående. Intensivvårdsavdelningen är en tekniktät miljö som kan upplevas skrämmande och stressig för patienten, vård på intensivvårdsavdelning kan orsaka posttraumatisk stress syndrom efter vårdtiden. Forskning visar att dagboken tillsammans med uppföljningsverksamhet efter vårdtiden på intensivvårdsavdelningen kan minska risken för utveckling av post traumatisk stress syndrom. Syftet med studien var att beskriva innehållet i patientens dagbok från vårdtiden på intensivvårdsavdelningen. Den vetenskapliga ansatsen är kvalitativ där datainsamling har skett genom insamling av totalt sju patientdagböcker från fyra olika sjukhus i Sverige. Analysmetoden kvalitativ innehållsanalys användes. Resultatet presenteras i 16 underkategorier och fem kategorier. Resultatet visar att innehållet i dagboken handlar om orsak till patientens sjukdomstillstånd och behandling, förändringar i andningen, patientens kommunikation, hälsofrämjande aktiviteter och beskrivningar av omvärlden. Kategorierna har sammanförts till ett tema där dagbokens innehåll ses som en verklighetsbeskrivning genom dialog grundad på uppmuntran och hopp. / Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård