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Bakgrund:  Compassion fatigue hos sjuksköterskor beskrivs som en minskad förmåga att känna empati till följd av att ha levt sig in i andra människors trauman, samtidigt ses empati som en av kärnorna i omvårdnaden. Många sjuksköterskor saknar kunskap i ämnet men drabbade sjuksköterskor beskriver det som en överväldigande känsla av att något är fel. Detta kan leda till att många sjuksköterskor funderar på att lämna yrket. Syfte: Syftet var att kartlägga faktorer till uppkomsten av compassion fatigue hos sjuksköterskor. Metod: En litteraturöversikt enligt Fribergs metod som baserades på elva kvantitativa och en kvalitativ artikel. Resultat: Resultatet presenterades utifrån fyra teman: empati, skuldkänslor och moralisk stress, personliga och sociala faktorer, arbetsrelaterade och organisatoriska faktorer samt ålder, arbetslivserfarenhet och professionalism. Några faktorer som orsakar compassion fatigue var hög grad av empatisk förmåga och hanteringsstrategier. Diskussion: Watsons teori om mänsklig omsorg och Conti O´Hares theory of the nurse as a wounded healer användes som teoretiska referensramar. Watson beskriver empati som en av kärnorna i hennes teori. Samtidigt som litteraturöversiktens resultat visade att högre grad av empati hos sjuksköterskan ger större risk att drabbas av compassion fatigue. Detta kan ses som motsägelsefullt då empati är en förutsättning för god omsorg. Conti O´Hares teori och resultatet stämmer överens i det avseende att om trauman hanteras på ett negativt sätt leder det till ohälsa. / Background: Compassion fatigue among nurses is described as a reduced ability to feel empathy due to being exposed to other peoples trauma, at the same time empathy is seen as one of the core values in nursing. Many nurses lack knowledge about the subject but affected nurses describes it as an overwhelmingly feeling that something is wrong. This may lead to a lot of nurses thinking about leaving the profession. Aim: The purpose was to identify the factors that lead to compassion fatigue in nurses. Method: A literature review according to Friberg´s method that is based on eleven quantitative articles and one qualitative article. Results: The results were presented on the basis of four themes: empathy, feelings of guilt and morol distress, personal and social factors, work related and organizational factors and also age, work experience and professionalism. Some of the factors that cause compassion fatigue were degree of empathetic ability and personal coping strategies. Discussion: Watson´s theory of human caring and Conti O´Hare´s theory of the nurse as a wounded healer was used as theoretical frame of reference. Watson describes empathy as one of the core values in her theory of human caring, at the same time the results of the literature review showed that nurses with a higher degree of empathy were at higher risk to develop compassion fatigue. This can be seen as contradictory when empathy is a condition in caring. Conti O´Hare´s theory and the result agree in the regard that if trauma is not handled in a positive way it may lead to illness.

Background: The literature suggests a consensus that individuals can become traumatised through listening to another’s trauma. Much of this research, however, has focused on individuals who have had direct, face-to-face contact with the primary victims of trauma. It therefore appears that there is a paucity of research looking at contact which is less direct, such as telephone contact. Aims: The current research aimed to explore the levels of secondary traumatic stress and posttraumatic stress disorder in a sample of Samaritan telephone volunteers, with a view to understanding some of the correlates of trauma. It also aimed to explore the personal construct systems of a sub-sample of Samaritan telephone volunteers, and explore any relationships between personal construct systems and trauma. Method: A cross-sectional design was employed. Questionnaires were used to assess levels of secondary traumatic stress and posttraumatic stress in Samaritan telephone volunteers spread across the United Kingdom. Repertory grid technique was used with a sub-sample of Samaritan telephone volunteers to elicit bipolar constructs comparing themselves and others. Results: 299 Samaritan telephone volunteers completed or partially completed the questionnaires, and of these 50 volunteers completed the repertory grids. Levels of secondary trauma (as determined by the Modified Secondary Trauma Scale) correlated with discrepancy in construing of the current and ideal self, levels of posttraumatic stress and exposure to potentially traumatic events. The Samaritans were not found to be suffering with secondary trauma. Degree of elaboration of self-construing reduced after the named traumatic event, and there was a significant difference in degree of elaboration for ‘self after traumatic event’ on the emergent poles of constructs. Conclusions: This research appears to be the first dedicated to assessing secondary trauma in telephone crisis line volunteers, lending some support to Sewell and Cromwell’s (1990) personal construct model of posttraumatic stress. The findings of this study challenge crisis lines to think about secondary trauma, and to implement some teaching and training around this area. Additionally, it reinforces that further research in the area is needed, and highlights the relative merits of employing a repertory grid methodology alongside questionnaires in understanding trauma.

Inledning: Det finns få forskningsreferenser när det gäller psykoterapeuters känslomässiga och kroppsliga reaktioner i patientarbete. Denna tematiska forskningsanalys utgår från psykoterapeuter som arbetar med personer som lider av trauma, då tidigare studier visar på kraftfulla kroppsliga och känslomässiga reaktioner i arbetet med denna målgrupp. Syftet med studien är att belysa hur psykoterapeuter beskriver sina upplevelser, negativa såväl som positiva, och hur de hanterar dem. Frågeställningar: Hur beskriver psykodynamiskt inriktade psykoterapeuter sina kroppsliga och känslomässiga reaktioner i arbetet med traumatiserade patienter? Hur hanterar de sina egna reaktioner? Metod: Fem legitimerade psykoterapeuter med psykodynamisk utbildning i Sverige och som arbetar med patienter med trauma har intervjuats. Till studien valdes en kvalitativ forskningsansats som bearbetades utifrån en tematisk analysmetod. Resultat: Psykoterapeuterna beskriver svårigheterna att möta det ofattbara våldet i patienternas berättelser, hur de skyddar sig, hur de bär hoppet, hur de kan stå ut och hur de kan använda sina reaktioner i terapin. Här lyfts också konsekvenser för dem och behovet av återhämtning. Diskussion: Resultatet diskuteras utifrån de teoretiska begreppen motöverföring, projektiv identifikation, härbärgering och trauma. Terapeuternas reaktioner bekräftar tidigare forskning av kroppsliga och känslomässiga reaktioner och diskuteras utifrån den omfattande påverkan reaktionerna har på terapeuterna yrkesmässigt och för privatliv. / Introduction: There are few research references on psychotherapists physical and emotional reactions in the patient work. This thematic analysis is based on psychotherapists who work with people suffering from trauma, as previous studies indicate powerful physical and emotional reactions in the work with this target group. The purpose of the study is to illustrate how psychotherapists describe their experiences, both negative and positive, and how they handle them. Questions: How do psychodynamic psychotherapists describe theirphysical and emotional reactions in the work with traumatized patients? How do they handle their own reactions? Method: Five licensed psychotherapists with psychodynamic training in Sweden working with patients with trauma were interviewed. This qualitative researchapproach was processed with a thematic analysis. Results: Psychotherapists describe difficulties facing the unimaginable violence in the patients' stories, how to protect themselves, how they carry hope, how they can cope with it and how they can use their reactions in therapy sessions. It also highlights the consequences regarding themselves and the need for recovery. Discussion: The result is discussed from the theoretical concepts of countertransference, projective identification, containment and trauma. The psychotherapists´ reactions confirm earlier research of physical and emotional reactions, and isbeing discussed out of the wide impact the reactions have on psychotherapists´ professional and personal life.

Therapists who specialize in trauma therapy are indirectly exposed traumatic events presented by clients within the therapeutic relationship. The potential consequences for trauma therapists may be the risk of vicarious trauma. Effective coping and self-care are essential in the practice of trauma work. The research question for this study is: Do coping skills and self-care practices in trauma therapists moderate the disruptive effect of vicarious trauma on the fulfillment of their psychological needs (trust/dependence and control)? The purpose of this research study was to examine quantitatively, the role of trauma therapists' beliefs in the effectiveness of coping skills and time spent devoted to self-care practices as moderators of the disruptive effect of vicarious trauma on their fulfillment of psychological needs of trust/dependence and control. Based on the constructive self-development theory, this study explored 2 psychological needs areas including trust/dependence and control. A sample of therapists with 10 years or more experience in the field and who primarily treated traumatized populations were recruited. A survey design methodology via a customized internet-based system was used to administer the trauma and attachment belief scale and the coping inventory scale. A hierarchical multiple regression analysis was completed to address the research question and hypotheses. The results of regression analysis supported the research question. Contributions to positive social change include increased awareness of the risk of vicarious trauma and potential coping strategies necessary to address this phenomenon. Therapists may then enhance their therapeutic effectiveness and organizational service delivery to traumatized client populations.

Medical interpreter services will be essential for developing and implementing culturally relevant interventions and treatment for limited English proficiency (LEP) populations. This study sought to identify the possible risks or protective factors that may be associated with vicarious traumatization (VT) or vicarious posttraumatic growth among medical interpreters in behavioral health settings. A 2-step cluster analysis was conducted yielding 2 distinct groupings of medical interpreters (Subtype 1, n = 73; Subtype 2, n = 101). The most important predictor determining the 2 subtypes was whether the participant had a personal history of trauma. In addition, there were significant differences between the 2 subtypes among the following variables: Trauma and Attachment Belief Scale T-scores of VT; years as a medical interpreter; years as a behavioral health medical interpreter; level of education as it relates to interpreting; personal history of trauma; personal or family history similar to any of the trauma survivors served in the past year; specific mental health training; sought personal therapy related to exposure to traumatic material from work environment; current relationship status; race; and whether spoken, sign, or both spoken and sign language interpretation was provided. The results of this quantitative study further support the constructivist self-development theory where VT is the result of the accumulated effects of repeated exposure to trauma material in combination with the person of the provider. Understanding these risk and protective factors will continue to support the provision of effective treatment of LEP individuals in behavioral health settings and the ongoing professional development of behavioral health medical interpreters.

Research has shown that video modelling can improve social behaviours in children with ASD. In addition, research in behaviour modelling training from the field of organisational psychology has shown that using a mix of positive and negative exemplars can assist in acquisition and generalisation of a skill. The current study compared the use of one negative and one positive exemplar, with the use of two positive exemplars to determine which combination would result in faster acquisition and/or superior generalisation of a skill. No other studies have examined this with children diagnosed with ASD. Seven children, aged between 5 and 15 years, and diagnosed with ASD participated in a multiple baseline design across children; within child across two modelling conditions; and within each modelling condition across two tasks. In one condition, a participant watched a video containing one exemplar of a model (same sex and of similar age but with normal development) perform a task the wrong way, and one exemplar of the same model perform the same task the right way (wrong/right). In another condition, the participant watched a video containing two different exemplars of the model perform a matched task the right way (right/right). During the intervention, 1 participant refused to watch the videos. For 13 of the 16 tasks, where training was completed, participants either reached criterion or made some gains in acquisition of the social skills. However, for seven of the tasks criterion was not reached. Generally, neither modelling condition was superior in acquisition or generalisation of the targeted social skills. Confounds occurring during the course of the study may have contributed to the equivocal results. For some children with ASD, video modelling in combination with the delivery of preferred reinforcers may be required for successful skill acquisition. Further implications, particularly the potential negative effects of vicarious reinforcement when an observer does not gain reinforcement for imitation are discussed, as are recommendations for future research.

<p>Svensk rätt tillämpar ett så kallat principalansvar. Principalansvar innebär ett ansvar för annans culpa och är med andra ord ett arbetsgivaransvar. Arbetsgivaren skall dock endast ersätta skada som arbetstagaren vållar i tjänsten. Gränsdragningen av vad som skall anses vara ”utfört i tjänsten” är dock inte tydlig i alla situationer. I NJA 2000 s 380 ansågs ett bedrägeri, vilket var utfört av en jurist, inte ha varit utfört i tjänsten. Frågan är dock om tolkningen av ”utfört i tjänsten” i rättsfallet var den mest ändamålsenliga med hänsyn till framtida rättsfall av samma art.</p><p>I uppsatsen redogörs för vad som enligt svensk gällande rätt är att anse som utfört i tjänsten, det vill säga omfånget av rekvisitet. Uppsatsen innehåller även en komparativ del, vari engelsk och tysk rätt behandlas avseende användandet av rekvisitet ”utfört i tjänsten”. Uppsatsen utmynnar i ett ställningstagande huruvida uttrycket enligt författarens mening tolkats rätt eller om det bör tolkas annorlunda mot vad som är fallet idag.</p>

Svensk rätt tillämpar ett så kallat principalansvar. Principalansvar innebär ett ansvar för annans culpa och är med andra ord ett arbetsgivaransvar. Arbetsgivaren skall dock endast ersätta skada som arbetstagaren vållar i tjänsten. Gränsdragningen av vad som skall anses vara ”utfört i tjänsten” är dock inte tydlig i alla situationer. I NJA 2000 s 380 ansågs ett bedrägeri, vilket var utfört av en jurist, inte ha varit utfört i tjänsten. Frågan är dock om tolkningen av ”utfört i tjänsten” i rättsfallet var den mest ändamålsenliga med hänsyn till framtida rättsfall av samma art. I uppsatsen redogörs för vad som enligt svensk gällande rätt är att anse som utfört i tjänsten, det vill säga omfånget av rekvisitet. Uppsatsen innehåller även en komparativ del, vari engelsk och tysk rätt behandlas avseende användandet av rekvisitet ”utfört i tjänsten”. Uppsatsen utmynnar i ett ställningstagande huruvida uttrycket enligt författarens mening tolkats rätt eller om det bör tolkas annorlunda mot vad som är fallet idag.