The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson’s Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.

<p>The Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first time mothers. While the effectiveness of the NFP has been established in the context of the US, and is currently being evaluated in the Canadian public health care system, little has been done to document how work of this nature influences or impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels. This qualitative interpretive descriptive study explored PHNs’ experiences of long-term home visiting a targeted population of young, vulnerable mothers in a Canadian NFP program. The study was conducted in two phases beginning with a secondary analysis of five focus groups conducted with public health nurses (N = 6) who delivered the NFP intervention as part of the feasibility and acceptability pilot in Hamilton, Ontario. This was followed by further exploration of identified themes and a practice, problem and needs analysis through individual, semi-structured interviews with the original focus group participants and all PHNs who have since delivered the NFP (N =10). Relationships formed with clients, the NFP program and support of NFP colleagues were rewarding factors while workload and workplace factors were significant contributors to stress. The study findings have implications for the identification of strategies to minimize staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improve program delivery.</p> / Master of Science in Nursing (MSN)

Social work practice in child welfare is widely acknowledged as a challenging field. Most social workers who choose to enter this field of practice do so with the knowledge that they will be exposed to difficult, at times traumatic, situations. They expect that the job will be stressful; that they will need to manage complex and challenging cases; and they will do so with few resources and often little public support. They also expect to be supported by their workplace in carrying out their mandated roles, however increasingly, a disconnect exists between those administer child welfare services and their understanding of front-line work (Herbert, 2007). Social workers’ wellbeing in child protection practice is directly affected by workplace culture; a subject that is often unexamined when addressing the high turnover of staff in the field. Instead, workers who leave child welfare practice – as well as though who stay while experiencing compassion fatigue or vicarious trauma - are viewed by administrators as being unsuitable for the work, a way of individualizing systemic issues (La Rose, 2009). This study sought to understand the ways that the culture of the workplace contributes to worker experiences of vicarious trauma, compassion fatigue and burnout. Survey research was conducted anonymously with child protection workers in Southern Ontario to understand the aspects of workplace culture that child welfare workers find helpful and supportive in managing the day-to-day of their work, as well as in addressing mental health in the workplace. From the seventy responses that were received, a number of themes emerged including Workplace Culture; Worker Well-being; Agency Support; Safety; Systemic Issues and Training. In this study, participants identified informal peer support and reflexive, supportive supervision as key areas that either sustained their practice or worsened their experiences. Workplace culture emerged as a significant factor in determining worker well-being and resiliency. Survey participants provided examples that illustrated clearly the ways in which neo-liberal policies and austerity measures have contributed to a workplace culture in which workers expressed feeling replaceable, devalued, and in precarious situations. Cutbacks to services and staffing, crushing workload and increasingly complex client situations contribute to the sense of being overwhelmed experienced by workers. Addressing experiences of compassion fatigue and vicarious trauma requires a paradigm shift from exclusively individual responsibility and towards an understanding of the broader systemic context and organizational responsibility (Antonopoulou, 2017; Mathieu, 2012; van Dernoot Lipsky, 2009). Organizational strategies to support worker wellbeing are shown to be significant factors in addressing and preventing compassion fatigue and vicarious trauma, ultimately preventing burnout and staff turnover. / Thesis / Master of Social Work (MSW)

A two week self-study was conducted to explore the use of self-care and its impact on well-being on the life of an art therapy graduate student. This study examined self-care through the use of weekly exercise, yoga and art as well as looking at the Wellness Evaluation of Lifestyle Notes that focused on five areas of well-being (Coping Self, Creative Self, Social Self, Essential Self, and Physical Self) which was documented bi-weekly. The literature review covers self-care, well-being and identifying barriers, the rationale for investing in self-care, and selfcare activities: exercise, yoga and art. Further implications of the use of self-care activities such as exercise, yoga and reflective art making were reviewed for clinical application in the field of art therapy, both for the client and art therapist. This research process allowed for an in depth exploration of the self, it furthered our knowledge regarding the efficacy of self-care and developed a deeper sense of self/self-awareness which benefitted our well-being personally and professionally.

Dairy producers play a central role in evaluating and seeking treatment or care for animal pain. The primary aim of this study is to examine dairy producers’ emotional states and professional quality of life and analyze the relationship between these variables and their perception of pain in dairy cattle. Dairy farm owners and managers of 65 southeastern U.S. herds participated in a survey that included demographic information, the Depression, Anxiety, and Stress Scale, a modified Professional Quality of Life Scale, and 23 items requiring participants to evaluate various painful conditions in cattle.

This study features an examination of the effects of working with traumatised individuals, namely vicarious traumatisation. Predictor variables such as age, career longevity, personal trauma history and workload were correlated with vicarious trauma. Support systems used by nurses were explored. The questionnaire consisted of items of the TSI Belief Scale, demographic characteristics of persons with a personal trauma history, work related aspects and support systems. Participants were 37 nurses (30 female and 7 male) who render a community mental health service in the Cape Metropole. Results of the study indicate that the variables age and career longevity were statistically significantly related to vicarious trauma. There was no relationship between personal trauma history, workload and vicarious trauma. The nurses identified the psychiatrist and psychologist as their main support systems in dealing with vicarious trauma. Recommendations were made to assist the organisation and nurses on how to deal with vicarious trauma. / Health Studies / M.A. (Health Studies)

Au cours du siècle dernier, des améliorations au niveau des conditions de vie ainsi que des avancées importantes dans les sciences biomédicales ont permis de repousser les frontières de la vie. Jusqu’au début du XXe Siècle, la mort était un processus relativement bref, survenant à la suite de maladies infectieuses et avait lieu à la maison. À présent, elle survient plutôt après une longue bataille contre des maladies incurables et des afflictions diverses liées à la vieillesse et a le plus souvent lieu à l’hôpital. Pour comprendre la souffrance du malade d’aujourd’hui et l’aborder, il faut comprendre ce qu’engendre comme ressenti ce nouveau contexte de fin de vie autant pour le patient que pour le clinicien qui en prend soin. Cette thèse se veut ainsi une étude exploratoire et critique des enjeux psychologiques relatifs à cette mort contemporaine avec un intérêt premier pour l’optimisation du soulagement de la souffrance existentielle du patient dans ce contexte. D’abord, je m’intéresserai à la souffrance du patient. À travers un examen critique des écrits, une définition précise et opérationnelle, comportant des critères distinctifs, de ce qu’est la souffrance existentielle en fin de vie sera proposée. Je poserai ainsi l’hypothèse que la souffrance peut être définie comme une forme de construction de l’esprit s’articulant autour de trois concepts : intégrité, altérité et temporalité. D’abord, intégrité au sens où initialement l’individu malade se sent menacé dans sa personne (relation à soi). Ensuite, altérité au sens où la perception de ses conditions extérieures a un impact sur la détresse ressentie (relation à l’Autre). Et finalement, temporalité au sens où l’individu souffrant de façon existentielle semble bien souvent piégé dans un espace-temps particulier (relation au temps). Ensuite, je m’intéresserai à la souffrance du soignant. Dans le contexte d’une condition terminale, il arrive que des interventions lourdes (p. ex. : sédation palliative profonde, interventions invasives) soient discutées et même proposées par un soignant. Je ferai ressortir diverses sources de souffrance propres au soignant et générées par son contact avec le patient (exemples de sources de souffrance : idéal malmené, valeurs personnelles, sentiment d’impuissance, réactions de transfert et de contre-transfert, identification au patient, angoisse de mort). Ensuite, je mettrai en lumière comment ces dites sources de souffrance peuvent constituer des barrières à l’approche de la souffrance du patient, notamment par l’influence possible sur l’approche thérapeutique choisie. On constatera ainsi que la souffrance d’un soignant contribue par moment à mettre en place des mesures visant davantage à l’apaiser lui-même au détriment de son patient. En dernier lieu, j'élaborerai sur la façon dont la rencontre entre un soignant et un patient peut devenir un espace privilégié afin d'aborder la souffrance. J'émettrai certaines suggestions afin d'améliorer les soins de fin de vie par un accompagnement parvenant à mettre la technologie médicale au service de la compassion tout en maintenant la singularité de l'expérience du patient. Pour le soignant, ceci nécessitera une amélioration de sa formation, une prise de conscience de ses propres souffrances et une compréhension de ses limites à soulager l'Autre. / Until the beginning of the 20th century, death was a relatively brief process occurring in the home, most often resulting from diverse infectious diseases. Nowadays, death predominantly occurs inside institutions, after a long battle with an incurable disease or due to the multiple debilities of aging. To understand and address patients' suffering at their end-of-life today, we must better grasp what this new type of death engenders in terms of emotional experience as much for the patient as for the clinician taking care of him. This thesis is an exploratory and analytical study of the psychological issues related to contemporary death with a prime interest for the optimization of existential suffering relief in this context. First, I will focus on the patient's suffering. Through an analytic review of the literature, I will propose a precise and operational definition of existential suffering in the end-of-life context, with some distinctive features. I will propose the hypothesis that suffering can be defined as a construction of the mind. This hypothesis will be articulated around the idea that existential suffering stems from three sources: integrity, otherness, and temporality. First, integrity in the sense that the patient initially feels threatened in his own person (relation to the self). Then, otherness in the sense that the perception of his external conditions has an impact on his distress (relation to the Other). And finally, temporality in the sense that the patient suffering existentially often seems trapped in a specific time frame (relation to time). After, I will focus on the clinician's suffering. In the end-of-life context, high-stake interventions such as palliative sedation or invasive treatments are sometimes brought up or even proposed by a clinician. I will describe many sources of suffering affecting the clinician and generated by his contact with the patient (examples of clinician's sources of suffering: damaged ideals, personal values, sense of failure, transference and countertransference reactions, identification processes, death anguish). Then, I will illustrate how these sources of suffering can constitute barriers to addressing the patient's suffering by influencing the choice of therapeutic approaches. Through this exercise we will discover that the clinician's suffering sometimes causes him to initiate interventions aimed at relieving his own distress at the expense of his patient. Finally, I will elaborate on how the encounter between a patient and a clinician can become a privileged context to address suffering. I will suggest ways of improving end-of-life care by providing a context of care that manages to put biotechnology in the service of compassion and by maintaining the singularity of the patient's experience. For the clinician, this will require an improvement of his training, an acknowledgement of his own sources of suffering and an understanding of his limits to help others.

From 2011 to 2031, the Canadian population living with neurological conditions is expected to double, but the population able to give informal care is not keeping pace, leading to a greater care burden. One element of this increasing care burden is emotional care. However, the effects of giving emotional care on caregiver health outcomes have not been sufficiently explored in the caregiving literature, where the majority of studies focus on instrumental forms of care, or fail to differentiate between different aspects of caregiving. This problem is further complicated by findings from other contexts which indicate that emotional supporting and helping others actually benefits the supporter or helper. Informed by the stress process and other ancillary theories, I use data from the 2012 General Social Survey to test several hypotheses which may help us understand the mental health, functional health, and caregiver burden of caregivers of persons with neurological conditions who emotionally support their care receivers, and of caregivers who are the sole provider of emotional support. The results suggest that emotionally supporting a care receiver with a neurological condition is detrimental to caregiver mental health, and that being the sole emotional supporter is detrimental to caregiver mental health, functional health, and experience of burden. A significant interaction effect also exists between emotional supporting and caregiver gender for functional health. These findings have important implications for future research, for intervention planners, and for caregivers themselves. / Graduate / 2020-08-06

Thesis (Ph.D.(Psychology))--University of the Witwatersrand, Faculty of Humanities, 2013. / The research entailed a comprehensive study of vicarious trauma in short-term insurance claims workers, compared to trauma counsellors and a control group of holiday booking consultants. A well-known, comprehensive model of compassion fatigue/secondary traumatic stress, developed for therapists formed the basis of the study. The research attempted to determine whether this model can be applied more widely to include administrative populations exposed to traumatised clients on a regular basis. To this end, the model was deconstructed into its eleven constituent parts and each element was investigated in addition to other variables of interest to the study. This was done to determine the importance and applicability of each model element and other selected variables to the administrative context. A mixed methods approach was utilised, which combined quantitative and qualitative data. The results yielded by the study were collectively utilised to construct an etic and an emic voice from the research. At the same time, effects from vicarious trauma were considered from an overarching bio-psychosocial stance, systematically gauging effects on various levels of functioning. Scores from quantitative measures on secondary traumatic stress, negative cognitive schemas, empathy, social support and compassion satisfaction were statistically analysed, which revealed significant differences between the worker groups. Widely accepted relationships between the study variables were tested and found to hold true within and across groups. Regression analysis determined the roles of empathy, social support and compassion satisfaction in vicarious trauma, as measured by secondary traumatic stress and negative cognitive schemas. In addition, constructivist selfdevelopment theory was employed to interpret the negative cognitive effects from vicarious traumatisation. Qualitative data were utilised to further elucidate the role and nature of vicarious trauma in each of the worker groups. The themes of exposure to client suffering, detachment, level of empathic engagement, personal trauma history and difficult life demands were unearthed from the qualitative data, which illuminated the importance and role of each of these elements to claims workers. Other areas of interest, being utilisation of sick-leave as a means to cope, work-related illness, attitudes towards professional counselling, feelings evoked by traumatised clients, and the language utilised by workers in response to client traumata were investigated. Further effects on participants as well iv as effects that reach beyond the person were identified and examined. Effects on the social and work contexts were also elucidated. Finally, interesting themes that emerged spontaneously from the data were considered. The consideration of the various model elements and other areas of interest systematically revealed that administrative workers dealing with traumatised clients are also affected by the process of vicarious trauma. Furthermore, the model was found to be largely suitable to the context of claims workers. However, the model was expanded to augment its usability within the more general administrative domain. Finally, the overarching aim was to enrich, contextualise and elaborate on the experiences of claims workers within their unique work context, to facilitate insight and a deeper understanding of vicarious trauma in more administrative populations that have largely been overlooked in research.

Paramedics are exposed to high levels of stress and trauma in their working environment. Research has its focus on the coping mechanisms and trauma incidents escalating into Posttraumatic Stress Disorder. This study examines the paramedics’ working environment in relation to the help available, and suggests a pastoral counselling method which may be utilized as an effective method of assisting in the coping process and prevention of PTSD. Emergency Medical Services as a helping profession is mainly concerned with the welfare of their patients. This study has its focus on helping the helper, with the main focus on assisting the paramedic to cope with his working environment. Implications of the research include kerugmatik counselling and narrative therapy, incorporated in a pastoral counselling method to assist the paramedic with the healing process. The main findings were that stress and coping of the paramedic in his working environment was a reality which was often overlooked, as these paramedics had their focus on caring for their patients. In most cases there is help available, but the paramedic is hesitant to seek it out. Paramedics are mostly self-reliant in their coping mechanisms as their understanding and relationship with God and with the church had been damaged. The researcher followed the four tasks of practical theology as theoretical framework, as explained by Osmer: Descriptive-empirical Task – Priestly listening Interpretive Task – Sagely wisdom Normative Task – Prophetic discernment Pragmatic Task – Servant Leadership / Thesis (MA (Pastoral Studies))--North-West University, Potchefstroom Campus, 2013.