Self-care behaviours and their relationship with Satisfaction and Compassion Fatigue levels among social workers

Compassion fatigue is a syndrome resulting from an empathic listening to the client’s distress. Social workers, by the relational nature of their task, can be at risk and may suffer from adverse health effects. This quantitative research (N = 270) aimed to assess the efficiency of social workers’ self-care practices. The conclusion is that personal and professional self-care practices reduce compassion fatigue levels as well as increase satisfaction levels. Promoting self-care practices will bring benefits for the professional and, therefore, in the client and the institution.     

Compassion satisfaction and compassion fatigue among medical social workers in Korea: the role of empathy

ABSTRACT

Medical social workers are affected by their clients’ suffering, which has an impact on social workers’ professional quality of life. This study examined the role of empathy in relation to professional quality of life among medical social workers in South Korea. Using the Professional Quality of Life Scale and Interpersonal Reactivity Index, we found that empathic concern and personal distress were significant components of empathy and were correlated with professional quality of life. Empathic concern was positively associated with compassion satisfaction and negatively associated with burnout. Personal distress was correlated with all components of quality of life: compassion satisfaction, secondary traumatic stress, and burnout. Women had significantly higher levels of burnout than men; religious affiliation was associated with higher levels of compassion satisfaction; and longer years of employment was associated with higher levels of secondary traumatic stress. Medical social workers should be educated on and trained in how empathy can help them address compassion fatigue and promote compassion satisfaction.     

In search of compassion: a new taxonomy of compassionate physician behaviours

Background

Compassion has been extolled as a virtue in the physician–patient relationship as a response to patient suffering. However, there are few studies that systematically document the behavioural features of physician compassion and the ways in which physicians communicate compassion to patients.

Objective

To develop a taxonomy of compassionate behaviours and statements expressed by the physician that can be discerned by an outside observer.

Design

Qualitative analysis of audio‐recorded office visits between oncologists and patients with advanced cancer.

Setting and Participants

Oncologists (n = 23) and their patients with advanced cancer (n = 49) were recruited in the greater Rochester, New York, area. The physicians and patients were surveyed and had office visits audio recorded.

Main Outcome Measures

Audio recordings were listened to for qualitative assessment of communication skills.

Results

Our sensitizing framework was oriented around three elements of compassion: recognition of the patient''s suffering, emotional resonance and movement towards addressing suffering. Statements of compassion included direct statements, paralinguistic expressions and performative comments. Compassion frequently unfolded over the course of a conversation rather than being a single discrete event. Additionally, non‐verbal linguistic elements (e.g. silence) were frequently employed to communicate emotional resonance.

Discussion and Conclusions

This study is the first to systematically catalogue instances of compassionate communication in physician‐patient dialogues. Further refinement and validation of this preliminary taxonomy can guide future education and training interventions to facilitate compassion in physician–patient interactions.     

Emotion, moral perception, and nursing practice

Abstract Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics.     

Health risks and the health care professional

Health care professionals are one of a large group of individuals who are exposed to significant risks by virtue of their occupation, such as the police, mountain rescuers, fire-service. The types of risk to which health care professionals are exposed are numerous, many of which remain largely unrecognised by the public and may even be underestimated by the professionals themselves. Examples of these health risks include fatigue, emotional/psychological trauma, physical injury caused by the use of machinery, back injuries, possible even violent physical assault from a patient or hospital visitor. There is also a very significant risk of acquiring an illness in the course of employment, for example, physical damage caused by the prolonged use of toxic substances, and also infectious diseases which are acquired by various routes, such as air-borne infections, needle-stick injuries. Subjective risk evaluation and the notion of risk in health care from the patients' perspective has been widely considered over many years, and in a number of different areas, including medical research, screening procedures, consent to surgery or other medical intervention. In this paper, however, the moral dilemmas which may arise for health care professionals in relation to health risks are highlighted and specific questions are raised. This revised version was published online in July 2006 with corrections to the Cover Date.     

Compassion and empathy in community social workers: A qualitative study in Spain

Compassion and empathy are considered to be elements of paramount importance in professionals working with individuals in need. However, the term ‘compassion’ generates controversy among social workers, while the term ‘empathy’ seems to be more universally accepted among these professionals. This qualitative study used a hermeneutic approach and aimed to explore and understand social workers’ experiences with empathy and compassion in the community setting. Between January and June 2019, nine in-depth interviews and two focus group sessions were conducted with social workers from community social centres and primary healthcare centres in the province of Almería (Spain), with a total of 23 participants. The software Atlas.ti 8.0 was used for discourse analysis. Professionals reported that it was necessary for them to have an empathic attitude towards service users, and claimed that being empathic towards individuals in need was a moral obligation. They also reported that, although being empathic is a trait of these professionals, they have to avoid being affected by it, and that there are situations that block empathy. With respect to their perception of compassion, different interpretations of the concept were found: some professionals understand compassion as pity; other professionals have difficulty understanding the term and other professionals understand compassion as help. It has become necessary to change and develop the very conceptualisation of compassion and to create compassion promotion programmes, as this is fundamental for the protection and satisfaction of social workers themselves and for the sustainability of the support they provide to individuals who are in great distress.     

Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation

A mixed method design was implemented to examine the spirituality and emotional well-being of Veterans Health Administration (VHA) chaplains and how potential changes in spirituality and emotional well-being may affect their professional quality of life. Four distinct categories of changes emerged from the narrative statements of a nationally representative sample of 267 VHA chaplains: (1) positive changes (e.g., increased empathy), (2) negative changes (e.g., dysthymic mood, questioning religious beliefs), (3) combination of positive and negative changes, and (4) no change (e.g., sustenance through spirituality or self-care). Most chaplains reported positive (37%) or no change (30%) in their spirituality and/or emotional well-being. However, quantitative analyses revealed that chaplains who reported negative changes endorsed greater burnout and secondary traumatic stress. Overall, these findings suggest VHA chaplains are predominantly spiritually resilient, but negative changes in the spiritual domain can occur, potentially increasing the risk of adverse changes in professional quality of life.     

Practical wisdom in health and social care: teaching for professional phronesis

The purpose of teaching ethics to nurses and other health and social care practitioners is not always clear. At the extremes of the continuum of aims sit (i) the teaching of ethics as a subject just like any other subject; and (ii) the teaching of ethics as a form of moral education. In this article, I outline the pedagogic tension this uncertainty creates before offering some insights into the educational implications of teaching ethics from the perspective of the ethics of Aristotle. In this conception, ethics is the pursuit of character development and specifically the development of practical wisdom, or what I have termed professional phronesis . I argue that while learning to approximate practical wisdom for nursing is possible, from the perspective of the ethics of Aristotle it is problematic for higher education. An Aristotelian approach has the potential to undermine the demarcation of teacher role as this is usually understood in higher education at the present time because, as I suggest, the best teachers of professional phronesis may turn out to be those practitioners (including practitioners of teaching) who exemplify the professional phronimos (or professionally wise practitioner).     

An empathetic beginning in education: exploring the prospects of self-regulation skills on pro-social behaviour in the early childhood environment

One avenue substantially researched and supported in early childhood research is the importance and the cultivation of self-regulation skills in the classroom. Most educational research on self-regulation skills has illustrated the importance between the enhancement of these skills and long-term academic success. Notwithstanding, there is little empirical research in early childhood that links the advancement of self-regulation skills to other contributing educational components, such as the cultivation of children's pro-social skills. This review seeks to establish a link between children's self-regulation and pro-social skills and discusses implications for future research and practice.     

Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers

The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents'' narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in ‘limit situations’ comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner''s dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being ‘broken’, being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters'' recovery.     

Crossing multidisciplinary divides: exploring professional hierarchies and boundaries in focus groups

Focus groups are an important element of qualitative health research, valued for the forms of knowledge and understanding that emerge from interactions among participants. Common advice for focus groups within health research is to limit the level of variation among respondents to generate comprehensive discussion and shared knowledge. In this article, the authors critically examine this advice, proposing instead that it is useful to acknowledge and, at times, consciously build in heterogeneity across categories of those present. The benefit of doing this is that the interaction thus generated can be used as a space within which to explore differing professional positions and interpretations of issues under discussion. Using research they have done, they explore the practical issues involved in getting different health and social care professionals together and go on to discuss the value and significance of using focus groups to explore the production of professional hierarchies and boundaries.     

Integrity and moral residue: nurses as participants in a moral community

Abstract This paper will examine the concepts of integrity and moral residue as they relate to nursing practice in the current health care environment. I will begin with my definition and conception of ethical practice, and, based on that, will go on to argue for the importance of recognizing that nurses often find themselves in the position of compromising their moral integrity in order to maintain their self‐survival in the hospital or health care environment. I will argue that moral integrity is necessary to a moral life, and is relational in nature. When integrity is threatened, the result is moral distress, moral residue, and in some cases, abandonment of the profession. The solution will require more than teaching bioethics to nursing students and nurses. It will require changes in the health care environment, organizational culture and the education of nurses, with an emphasis on building a moral community as an environment in which to practise ethically.     

Abbreviated Mindfulness Intervention for Job Satisfaction,Quality of Life,and Compassion in Primary Care Clinicians: A Pilot Study

PURPOSE

Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians.

METHODS

A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures.

RESULTS

Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales—Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale.

CONCLUSIONS

In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.     

A case for the ‘middle ground’: exploring the tensions of postmodern thought in nursing

Abstract Diverse beliefs about the nature and essence of scientific truth are pervasive in the nursing literature. Most recently, rejection of a more traditional and objective truth has resulted in a shift toward an emphasis on the acceptance of multiple and subjective truths. Some nursing scholars have discarded the idea that objective truth exists at all, but instead have argued that subjective truth is the only knowable truth and therefore the one that ought to govern nursing's disciplinary inquiry. Yet, there has been relatively little critical debate or dialogue about the implications of adopting subjective and multiple truths as a maxim to govern the discipline. In this paper we examine what it might mean to adopt subjective forms of truth as the only knowable truths for nursing, and to accept the possibility of multiple co‐existing realities. We understand the implications of such a philosophical stance for the epistemological basis of a practice science to be considerable, therefore we consider what it might mean for a practice‐based discipline such as nursing to remain ambiguous on the question of truth, and examine the implications of failing to achieve consensus on what constitutes a truth claim. On the basis of this examination, we urge a cautious approach to the extremes of either position and argue for a more thoughtful and rigorous dialogue about ‘truth’ and knowledge in nursing practice, education, and research.     

Teaching health care ethics: the importance of moral sensitivity for moral reasoning

Abstract My discussion reflects on the nature of moral sensitivity. The inquiry is guided by a pedagogical concern: if the goal of teaching practical‐minded nurses about health care ethics is to develop the capacity to be aware of ethical implications of certain acts, events and treatments in the health care setting as well as the skills to resolve ethical dilemmas, it seems important to have a clear sense of what it means to be morally sensitive. How, for example, does a health care worker come to recognize in a particular and institutionally defined situation his or her moral responsibilities towards the other? What exactly is moral sensitivity? Is it something that academic philosophers can teach? I argue that moral sensitivity is a capacity for relatedness indispensable to moral theorizing that can be either cultivated or undermined and therefore ought not to be ignored by educators nor those responsible for ethically weighted decision‐making situations.