No description available.

The purpose of this study is to explore Filipino service care providers’ experience of compassion fatigue. Compassion fatigue is a common experience among health care professionals and can contribute to feelings of hopelessness and adverse behaviors in caring for patients. In California, there are a large number of Filipinos who are employed as care providers for older adults; however, there is limited research available regarding Filipino workers in the United States. This study took on a qualitative design that utilized face-to-face interviews to gain more insight into Filipino service care providers’ experience of compassion fatigue in relation to their employment. Factors that were explored in interviews were exposure to terminally ill individuals, coping and self-care strategies, and working environments. The results of this study indicated participants appeared to experience compassion satisfaction, rather than compassion fatigue. Furthermore, recommendations for future research were discussed. These recommendations included the need to explore experiences of compassion satisfaction in this population and to look into the experience of Filipino service care providers who were born in the United States, rather than in the Philippines, to determine whether Filipino cultural values of caring can act as a buffer against the effects of compassion fatigue.

No description available.

No description available.

Background: Several nursing theorists emphasize the importance of establishing the so-called therapeutic relationship between the nurse and the patient in order to facilitate and provide better results of the treatment. Aim: The aim of this study was to investigate how nurses working in out-patient psychiatric care describe the concept of therapeutic relationship and its usage when working with patients. Method: Semi structured interviews were performed and the material was analyzed through qualitative content analyzis. Result: Four main categories that describe the different aspects of the therapeutic relationship emerged. These were: What the nurse does to establish the therapeutic relationship, The functions and definition of the therapeutic relationship, The qualifications of the therapeutic relationship and Challanges in establishing the therapeutic relationship. Conclusion: The therapeutic relationship was described as a tool in working with the patient, and individualized treatment, trust, sufficient time and the use of one's own personality was described as important factors in establishing this relationship.

Objective: According to the Joint Commission (2012), about 80% of serious medical errors are related to miscommunication between healthcare providers. The Joint Commission (2012) recommended the utilization of standardized communication tools to reduce the number of medical errors related to the miscommunication. The Situation-Background-Assessment-Recommendation (SBAR) communication tool is a standardized tool that has been used to improve the effectiveness of communication between healthcare providers. The purpose of this project was to evaluate the effectiveness of using SBAR communication tool for warm handoff between primary care providers and behavioral health providers in order to provide a continuous and complete transition of care for patients with psychiatric disorders or psychosocial issues. Method: A mixed method design was implemented in an integrated primary care clinic at two locations in Phoenix, Arizona. A brief presentation about the SBAR tool and copies of the SBAR tool was provided for the clinic staff. Data were gathered from four participants (two nurse practitioners and two behavioral health workers) using structured observation, pre-and post-test surveys, and structured interviews. Length of study was one month. Results: During the data collection, there were 40 observed warm handoffs, 12 unobserved warm handoffs between primary care nurse practitioners and behavioral health workers. Seventy-five percent of the participants felt that the SBAR helped them in organizing their thoughts and providing/obtaining adequate information during warm handoff. They reported satisfaction when using the SBAR tool. There was no statistically significant difference in the scores of collaboration and satisfaction about care decisions between pre and post-SBAR intervention. Conclusion: The SBAR communication tool has the potential to improve communication between primary care providers and behavioral health workers to improve the quality and safety of care for patients with psychosocial concerns. Utilizing SBAR may increase teamwork and ensures adequate hand-off information on the warm handoff. Multiple PDSA cycles should be conducted to refine the change and make it applicable and sustainable in the integrated care setting.

HIV/AIDS is an important health issue worldwide, and in Tanzania the estimated amount of people living with HIV year 2012, was around 1,5 million people. Many of them are living a restricted life at home, leaving the responsibility of care to their next of kin. This leads to a big number of care providers lacking both financial and educational resources, making it difficult to provide care. The aim of this study was to investigate next of kin’s experiences of being a care provider for a relative infected with HIV/AIDS. A qualitative design with semi-structured interviews was chosen and data were analysed using the qualitative content analysis. The result showed that the majority of care providers lived in poverty and experienced a lack of resources, unabling them to give sufficient care to the patients. Many care providers were depending on the support of food, finances and practical help from organizations, neighbours and relatives. Common care providing tasks consisted of helping the patients with their personal hygiene, washing their clothes and bed sheets, cooking, cleaning and looking after the whole family. These chores limited them to attain a sustainable income, leading to a lack of financial security. The lack of security was also amplified by a lack of training in how to give good care. According to WHO, counselling must be offered to patients infected with HIV/AIDS. However, the result in this study shows the importance of including next of kin in the counselling criteria, as they are in need of advice and education in how to give care. Care providers’ commitment to the patients was particularly visible in the lives of women, who chose to put their own future plans aside for the sake of their sick close ones. As limited resources made it difficult to provide good care, more research needs to be done about the need of sustainable support to care providers in Tanzania. / Program: Sjuksköterskeutbildning

The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data. In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout. The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation. Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.

Previous research on grandparents as kinship care providers demonstrated that grandparents are confronted with both challenges and rewards. Using qualitative research methods, I examined the lives of 35 black aunts who served as kinship care providers for nieces and nephews. I found that grandparents and aunts experienced increased time demands, financial burdens, and family stress. However, this study demonstrated that aunts’ experiences differ from grandparents’, due to the younger age of aunts and the fact that aunts are of the same generation as the biological parents. Moreover, I found that aunting, or the care and nurture of children by aunts and great-aunts, is gendered and invisible work that, at the most basic level, salvages children’s lives. Salvaging children’s lives involved three non-linear stages: making the decision to become a kinship care provider, transitioning from aunting to parenting, and parenting nieces and nephews. I utilized a synthesis of symbolic interactionism and black feminist thought as a theoretical framework that examines how the meanings that black women attach to family influence their definitions of self and affect their decisions to act on behalf of family members. These findings extend the research on black women’s lives and on kinship care within black families. I used a narrative style that allows the respondents’ voices to be heard, as these are their stories. I offer suggestions for future research, as well as outline a number of policy and theoretical implications. This research is important because black children are disproportionately represented within the child welfare system. If interventions and policies are to influence other black women or black men to accept responsibility for many of the most at-risk children in their families and neighborhoods, research must explore and report the challenges, sacrifices, costs, and rewards of becoming kinship care providers within black families.

<p>Hypoxic ischemic encephalopathy (HIE) is a serious birth complication of full term infants; 40-60% of affected infants die by 2 years or have severe disabilities. Infants with HIE often have a normal gestation and parents anticipate a healthy birth. HIE can be managed with aggressively with moderate hypothermia < 6 hours of life, cardiopulmonary support, and seizure management. Experimental interventions such as moderate hypothermia > 6 hours of life and umbilical cord stem cell transplant are also available. Additional decision-making for these infants may include long-term developmental therapy, nutritional support, and respiratory support. However, who makes these decisions, what factors influence decision-making and the long-term impact of decision-making on parents and health care providers remains unknown. Therefore, the purpose of this study was to explore parental and health care provider decision-making for infants with HIE.</p><p>A longitudinal case study design was used to study 11 cases of infants with HIE. Each case included the infant, the parent, and the infant's providers. Infant medical record data, interviews and questionnaires were used to collect data from infant birth through 6 months of age. Content analysis was used to analyze the interviews. Descriptive statistics were used with the questionnaires. Visualization techniques were used to search for patterns and trends in the assembled data. </p><p>All infants required resuscitation and their treatment plans included aggressive care or aggressive and experimental care. The level of parental participation varied with in the first week of life depending on whether the infant was enrolled in experimental interventions plus aggressive care or only aggressive care. Parental hopefulness was lower in parents of infants who received experimental interventions, but the infants receiving experimental interventions were less critically ill than infants who received aggressive care only. Parental stress was also lower among parents of infants who received experimental interventions over the first 2 months of life. </p><p>Parents were concerned about the short and long-term impact of HIE, few parents understood that even though their infant had appropriate developmental outcomes at 6-months that did mean that neurological damage occurred. However in one case of an infant, the neurological development became central to the parental decision-making for the infant. Parents became less hopeful as diagnostic examinations continued find more complex conditions that were individually not problematic for the parents, but when the complexity of the infant's illnesses continued to unfold, parents feared that too many complications existed for their daughter to have an acceptable quality of life. Yet, when parents broached the topic of transitioning from aggressive care to palliative care with providers, they were told that withholding/withdrawing treatment was not appropriate for the infant. Not discussing withholding or withdrawing treatment ultimately created conflict between parents and providers due to differences in opinions about the predicted neurological outcomes for the infant. The conflict led to distrust and parents regretted most decisions they made for their infant. </p><p>Parental and provider decision-making is complex and many of the decisions within the 6-month trajectory were made within the first 6 hours of birth. Parents felt that the decision-making was appropriate in most cases, but the extent of the infant's injury remains unknown. How parents will evaluate the decision-making when the infant begins to miss developmental milestones is unknown. Results from this dissertation suggest that decision-making is a trajectory and decisions are not made in isolation. Implications for practice include discussing and educating parents during the first 6 months and later about developmental milestones and the importance of continuing therapy, even when the infant appears normal. Providers can also acknowledge to parents, up front, that the extent of the neurological injury is unknown and different providers may have different opinions about the long-term effects. By acknowledging these differences, providers can begin discussing the treatment options with parents and educating them about the specific needs of their infant.</p> / Dissertation