Hospice volunteers are a high-risk group for anxiety and depression owing to their frequent exposure to patients at the end of life and their subsequent deaths. Resilience is known to be a powerful factor that affects the occurrence of anxiety and depression; however, research on this subject is scarce. We investigated the relationship of resilience with anxiety or depression in hospice volunteers. A total of 145 volunteers were included in the analysis. Participants completed self-reported scales, including the Korean version of the Connor-Davidson Resilience Scale, the State-Trait Anxiety Inventory, Patient Health Questionnaire-9, and the Professional Quality of Life Scale version 5. Pearson correlation coefficients were analyzed to identify the relationship of compassion satisfaction and compassion fatigue with anxiety or depression. A PROCESS macro mediation analysis was used to investigate the mediation effects of compassion satisfaction and compassion fatigue on the relationship between resilience and anxiety or depression. There were significant associations of compassion satisfaction and compassion fatigue with anxiety and depression. The relationship between resilience and anxiety/depression was mediated by compassion fatigue, which had indirect effects on anxiety and depression. Efforts to reduce compassion fatigue and increase resilience could help prevent anxiety and depression in hospice volunteers.
Working with terminally ill patients is regarded as a stressful or traumatic event and may lead to negative outcomes, including job burnout and secondary traumatic stress (STS). Psychological resilience might protect employees from the negative consequences of stress. The aim of this study was to determine the mediating role of job burnout in the relationship between psychological resilience and STS. The study included 72 nurses aged from 22 to 72 years old (M = 46.01, SD = 10.69), working with terminally ill patients. The recipients completed 3 questionnaires: the Secondary Traumatic Stress Scale, the Oldenburg Burnout Inventory, and the Resilience Measurement. The results reveal negative associations between resilience, job burnout, and secondary traumatic stress, and a positive correlation between secondary traumatic stress and job burnout. Mediation analysis showed that job burnout plays a mediating role in the relationship between psychological resilience and secondary traumatic stress. Our findings highlight the role played by job burnout in the manifestation of STS. Professional and nonprofessional interventions for individuals experiencing work-related traumatic stress would benefit from interventions that build personal resources.
Background: Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France.
Methods: A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis.
Setting: Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews.
Participants: 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French.
Interventions: The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care.
Main outcomes and measures: The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs.
Discussion: Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed.
Trial registration: ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.
Dans cet article, l’auteur présente les bases théoriques et techniques du dispositif de médiation transculturelle mis à la disposition des équipes de soins palliatifs. Accompagner une famille dans cette épreuve est un défi pour toutes les équipes soignantes. Ce défi peut se révéler plus complexe encore lorsque soignants et parents ne partagent pas les mêmes références culturelles. Dans des situations d’impasse thérapeutique, la prise en compte du fait culturel – considéré non plus comme un frein, mais au contraire comme un catalyseur formidablement actif – peut non seulement enrichir l’interprétation médicale, mais aussi rendre possible une réelle rencontre entre le patient et son médecin.
OBJECTIVE: Oncologists are exposed to suffering, loss, and death, which can potentially lead to grief reactions. Although grief over patients may be a natural consequence of the close and longstanding oncologist-patient relationship, the empathy that oncologists feel towards their patients may put them at risk for compassion fatigue (CF). This study examined the mediating role of the two components of CF - secondary traumatic stress (STS) and burnout - in the relation between empathy and grief among oncologists.
METHOD: Participants included 71 Israeli oncologists. Measures consisted of a demographic questionnaire, the Texas Revised Inventory of Grief-Present, the Interpersonal Reactivity Index, and the Professional Quality of Life questionnaire.
RESULTS: Oncologists reported moderate levels of grief, and relatively high levels of both STS and burnout. In addition, they reported high levels of the three components of empathy: perspective-taking, empathic concern, and personal distress. The PROCESS SPSS macro revealed support for the mediation model. The mediators (STS and burnout) fully accounted for the relationship between the following two components of empathy - perspective-taking and personal distress - and grief.
CONCLUSIONS: Oncologists commonly experience grief over patients. We found that oncologists' grief was related to their empathy, and that this association was explained by their levels of CF. The current research may mark a step toward recognizing oncologists' grief as well as understanding the processes associated with it.
La rédaction des directives anticipées est perçue difficilement car elle donne l'impression de "graver dans le marbre" une situation inconnue au moment de l'écriture. Comme cela a été souvent souligné, ce que l'on craint pour cette période va de l'abandon à l'obstination déraisonnable, avec toute une échelle de sentiments entre ces deux bornes.
L'association américaine CODA-ALLIANCE (San José) a proposé sous forme d'un jeu de cartes, une liste de souhaits.
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Ce travail explore les synergies pleines de promesses entre un art du tatouage et le travail de deuil. En renouant avec sa fonction ancestrale éclairée des connaissances de la psychologie moderne en la matière, l’artiste tatoueur se présente comme ayant une nouvelle proposition d’aide pour l’endeuillé. De l’élaboration du dessin, pensée comme un support à la quête de sens provoquée par la mort d’un proche, à la cérémonie de tatouage, utilisée comme un rituel de transformation de la douleur, l’art du Tatouage comme aide au travail de deuil se propose comme une aventure intérieure qui conduit l’endeuillé de la tristesse à la joie d’un renouveau.
Dans le cadre d’une recherche sur la littérature jeunesse dans l’accompagnement de l’enfant orphelin, ce travail porte sur les livres pour les très jeunes enfants. 21 albums destinés à des enfants de 3 à 6 ans, publiés en langue française au 21e siècle, rendent compte des interrogations des jeunes héros. La littérature jeunesse semble être un médiateur susceptible d’aider l’enfant orphelin à dépasser l’absence et vivre avec le souvenir du défunt.
The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.
BACKGROUND: The nursing role includes providing compassionate care at the end of life, yet many nurses feel unprepared to provide such care. We describe nursing students' reactions during participation in an experiential immersion in palliative care in which they interacted with seriously ill patients through gifting handmade shawls.
METHOD: After gifting, students wrote three words that best described the feeling in the room. Responses were content-analyzed to assess the frequency of specific concepts produced in the Three Words task. Gifting Reflection narratives were used to characterize the content-analysis categories.
RESULTS: Nursing students' most common responses were reflected in the categories Comfort and Kindness, and Thankfulness and Appreciation. Students also reported Sorrow and Need, but positive themes of Happiness and Delight, and Calm and Reflective were equally as prevalent.
CONCLUSION: Experiential learning that focuses on psychosocial learning can result in nurses having positive, meaningful experiences in caring for seriously ill patients.
À partir d’une recherche exploratoire qualitative, l’objectif de cet article est d’évaluer les effets de la prise en charge psychologique médiatisée par la poésie chez quatre femmes atteintes d’un cancer du sein. L’analyse qualitative met en évidence les principaux thèmes des poèmes des participantes. L’étude des poésies réalisées par une patiente permet d’illustrer les bénéfices apportés par cette prise en charge. L’usage de la poésie par un psychologue clinicien comme médiation à la parole avec des patientes souffrant de cancer est une modalité de prise en charge thérapeutique originale qui semble adaptée aux besoins de certaines patientes.
The dilemma of patients’ capacity to refuse medical care occurs frequently in inpatient settings and often involves a psychiatric consultation.Though end-of-life decisions are generally considered the realm of palliative care specialists and ethics committees, consultation psychiatrists may play a role in these complex situations as well. Resolving a clinical dilemma that clearly precipitates withdrawal of treatment and patient death, or which results in additional suffering over a patient's objections, may present a moral burden to the psychiatrist tasked with a consult for capacity to refuse treatment.
BACKGROUND: Compassion fatigue among health care professionals has negative effects on patient care. Providing end-of-life care, hospice nurses may be particularly at risk for compassion fatigue.
OBJECTIVE: The purpose of this study was to investigate self-esteem and affect as mediators between psychological distress and compassion fatigue among hospice nurses (N = 90).
DESIGN AND MEASUREMENTS: Hospice nurses working in a health care setting were recruited to complete a survey. Multiple mediation analysis was used to explore associations between variables of interest.
RESULTS: Psychological distress was associated with greater compassion fatigue and had an indirect effect on compassion fatigue through lower self-esteem and higher negative affect, but not through positive affect.
CONCLUSION: Among hospice nurses, psychological distress may reduce self-esteem and create negative feelings, thereby increasing the risk of compassion fatigue. Interventions that target both the cognitive and affective links between psychological distress and compassion fatigue may be most effective.
Deux conceptions de la mort s'opposent : l'une fait de la mort la fin de la vie et ouvre au rien, pour l'autre la mort est un passage vers une autre vie, une transformation. Dans toutes les cultures, la mort est associée à un "après". Ces deux imaginaires ont des conséquences sur la vie de chacun et revêtent dans le contexte des soins palliatifs une dimension particulière pour les malades comme pour les soignants. Cinq soignants en soins palliatifs passent un protocole qui favorise l'expression de l'expérience subjective en utilisant le thème de l'arbre afin d'évoquer la mort de manière analogique. La mort est très présente, répartie en deux thèmes, la mort-fin (64%) et la mort-transformation (36%). Deux protocoles montrent que la mort-fin est clairement identifiée, mais peut être combinée afin de contribuer au processus de transformation continuel à l'oeuvre dans la vie. Cette perspective ouvre à un avenir sans lequel la vie ne peut s'établir. (R.A.).
Origine : BDSP. Notice produite par APHPDOC R0xCG8pJ. Diffusion soumise à autorisation
OBJECTIVE: Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life.
METHOD: A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits. Result: Nineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance.Significance of results: Our findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.
BACKGROUND: Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics).
OBJECTIVE: The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC).
DESIGN: This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities.
SETTING/SUBJECTS: A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city.
MEASUREMENTS: Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding.
RESULTS: Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes.
CONCLUSIONS: The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.
This article reports results from a systematic search and thematic analysis of qualitative literature to identify key issues related to family-centered care, behaviors, and communication skills that support the parental role and improve patient and family outcomes in the pediatric intensive care unit. Five themes were identified: (1) sharing information, (2) hearing parental voices, (3) making decisions for or with parents, (4) negotiating roles, and (5) individualizing communication. These themes highlight several gaps between how parents want to be involved and how they perceive clinicians’ engagement with them in the care of their child. Parental preferences for involvement differ in the domains of information sharing, decision making, and power sharing across a spectrum of parental roles from parents as care provider to care recipient. The pediatric intensive care unit setting may place clinicians in a double bind trying to both engage families and protect them from distress. Asking families of critically ill children about their preferences for participation across these domains may improve clinician-family relationships.
BACKGROUND: There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development.
METHODS: Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar.
RESULTS: Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified.
CONCLUSION: Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
CONTEXT: Meaning in life (MiL) is a key factor for ensuring spiritual wellbeing and quality of life among patients with life-threatening illnesses. However, the role of MiL in relation to the wish to hasten death (WTHD) and its interaction with other physical and psychological factors in patients with advanced cancer has not yet been studied.
OBJECTIVE: To analyse the relationship between the WTHD and MiL, and to propose a theoretical model of functional relationships between WTHD, performance status, depression and MiL.
METHODS: Cross-sectional study of 101 patients in a palliative care unit, who were assessed in the context of a clinical interview. Outcome measures included performance status, depression, MiL and the WTHD. Structural equation modelling (SEM) was used to analyse the functional relationships between these factors.
RESULTS: The WTHD correlated significantly (p < .01) with MiL (r = 0.60), performance status (r = 0.548) and depression (r = 0.397). The SEM analysis showed that although there was no significant direct effect between performance status and the WTHD, there was a significant total effect, due to the mediation of depression and MiL. The latter played the most significant role, accounting for 76.5% of the mediation.
CONCLUSION: These results support the proposed model and provide evidence of a mediator effect of MiL and depression on the relationship between physical impairment and the WTHD in advanced patients. Our findings suggest that interventions to enhance MiL could help to address and/or prevent the emergence of a WTHD in this population.