Angela L. Lamson

Compassion fatigue and secondary traumatization: provider self care on intensive care units for children.

INTRODUCTION Unexpressed grief in health care providers who care for chronically ill children may lead to the development of some symptoms of compassion fatigue. The purpose of this study was to describe the scope of compassion fatigue in health care providers working on critical care units with children. A secondary aim was to evaluate the effectiveness of providing educational seminars on compassion fatigue to health care providers working on critical care units with children. METHOD In this quantitative study, 185 providers employed within a Childrens Hospital attended an educational seminar and voluntarily completed the questionnaires before and after the seminar. A modified version of the Social Readjustment Rating Scale, Index of Clinical Stress, and a compassion fatigue measure developed by the researchers were used in this study. RESULTS The researchers found that this educational seminar was successful in raising awareness on compassion fatigue and reducing clinical stress. In addition, the results suggested that providers who experienced higher levels of personal stressors also experienced higher levels of clinical stress and compassion fatigue. DISCUSSION Providers working on the intensive care units for children needed to be aware of compassion fatigue symptoms and techniques to manage or minimize their symptoms. Taking care of the providers on a personal and professional level had a significant impact on the amount of stress and compassion fatigue exhibited by health care professionals.

Secondary traumatization in pediatric healthcare providers: compassion fatigue, burnout, and secondary traumatic stress.

The primary aim for this research was to explore the overlap and differences between the concepts related to secondary traumatization: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), compassion fatigue (CF), and burnout (BRN). A secondary aim for this research was to examine the impact of secondary traumatization and some of the personal and professional elements that affect how pediatric healthcare providers experience PTSD, STS, CF, and BRN. An online survey was sent via e-mail to numerous list serves for healthcare providers who had worked on PICU, NICU, or PEDS units within the last year. The analyses revealed that a significant overlap existed between the terms of STS, PTSD, BRN, CS, and CF for PICU, NICU, and PEDS providers. However, a hierarchical linear regression revealed a significant amount of unique contributions to the variance in CF based on each of the measured concepts. Despite previous literature that indicates that the terms STS and CF can be used interchangeably, the two most prominent measures utilized in the assessment of CF and STS are actually capturing at least some unique elements. Given these results, future researchers should examine and conceptualize the difference in etiology, prevalence, symptoms, and treatment efficacy for CF and STS as separate but related entities and then return their focus to understanding secondary traumatization in healthcare providers.

Introduction to Medical Family Therapy: Advanced Applications

Medical Family Therapy is a burgeoning field grounded in the biopsychosocial-spiritual framework and systemic perspective. Its contributions extend from the 1980s when it was first recognized in a primary care setting (family medicine) to today where it has extended into secondary, tertiary and other specialized healthcare contexts. Its contributions span clinical, educational, research, and policy arenas. The development of a Medical Family Therapy Health Care Continuum, as depicted in this chapter, allows for members of all healthcare disciplines to determine the scope and depth of skill they want to develop through reading this text, Medical Family Therapy: Advanced Applications, as well as continue to pursue through other methods of professional development.

A collaborative care model for patients with Type-2 diabetes.

The research on diabetes has shown the need to move from a traditional medical model to a patient-team orientation. This has led to a number of collaborative programs targeting the patient and familys comprehensive needs. This paper details one collaborative care program for underserved patients with Type-2 diabetes set in rural, eastern North Carolina. Roles of the therapeutic team are incorporated along with a case example highlighting the bio-psychosocial-spiritual model in action. Sustainability, challenges, and strengths are included to facilitate a realistic appraisal of the program.

Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program

BackgroundChanges in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL.MethodsA sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate.ResultsOverall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression.ConclusionsWe encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth’s BMI changes, but also psychosocial changes including QOL.

Camp Golden Treasures: a multidisciplinary weight-loss and a healthy lifestyle camp for adolescent girls.

Camp Golden Treasures, (CGT) the first non-profit weight loss camp for overweight adolescent girls in the nation, was held for six weeks from June 24 to August 3, 2007 at the East Carolina University campus in Greenville, NC. The primary goal was to support campers to lose weight, raise self esteem, and to learn the tools necessary to lead a healthy lifestyle while reducing risks for developing chronic disease or mitigating the effects of existing obesity-related conditions (sleep apnea, insulin resistance, hypertension, lower extremity dysfunction, etc.). While at CGT, campers learned about the importance of physical activity and proper nutrition through workshops, discussion groups and hands-on activities. Additionally campers were taught the necessary tools and strategies needed to make concrete, positive lifestyle changes so they can achieve a healthy weight. Due to the nature of a chronic disease such as obesity, multidisciplinary collaborators including physical therapy, nutrition, health education, management, family therapy, risk management, fundraising, public relations, medical, nursing, and physician coverage were involved in designing, planning, and implementing CGT.

Patient and provider relationships: consent, confidentiality, and managing mistakes in integrated primary care settings.

Health care in the United States is advancing toward increasingly integrated primary care systems. With this evolution comes a responsibility for providers to carefully consider a variety of issues related to ethical conduct. While working within the same teams on behalf of the same patients and families, professionals representing different disciplines are guided by different sets of baseline ethics guidelines and codes-and the overlap and differences between these principles can easily translate into ethical breaches. Using a clinical vignette as the basis for our discussion, we address issues of informed consent, confidentiality, and grievance procedures specifically. We review extant literature and formal ethics codes upheld by nine leading professional organizations across these foci, offer recommendations about how to manage this clinical scenario, and highlight what is needed to advance our understanding of integration ethics.

The State of Dyadic Methodology: An Analysis of the Literature on Interventions for Military Couples

ABSTRACT Military members and their spouses experience unique stressors compared with civilian couples, making them distinctively vulnerable to a number of marital and mental health concerns. However, the amount and quality of intervention research to guide treatment for military couples are unknown. Therefore, a systematic literature search of interventions for military couples was completed resulting in 10 articles that met the studys inclusion and exclusion criteria. Further, a rubric to assess dyadic methodology was created and utilized to determine the dyadic quality of the methodology of the sampled articles. The results of the systematic literature review revealed that (a) there are few evidence-based interventions for military couples in which both members of the dyad are included and (b) the methodology by which treatments are evaluated largely do not employ systemic or dyadic measures. Recommendations for future research with military couples includes the need for couple-focused interventions using experimental methodology, systemic theories to guide intervention and research, and appropriate dyadic assessment and analysis tools to determine the effectiveness of couples interventions for military, reserve, and veteran populations.

The clinical, operational, and financial worlds of neonatal palliative care: A focused ethnography

OBJECTIVE Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center. METHOD In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families. RESULTS Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support. SIGNIFICANCE OF RESULTS The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

Supervision in Behavioral Health: Implications for Students, Interns, and New Professionals

Behavioral health providers (BHPs) are trained by their respective programs and professions on the importance of communicating with other professionals around patient care, yet few are trained on how to provide collaborative care and work as part of a team. New clinical innovation models, such as integrated care, punctuate the need to further develop training methods to best equip the next generation of BHPs to work in collaborative settings. Supervision is a tool that students, interns, and new professionals can use to help them navigate new and unfamiliar territory in health care settings. This manuscript will describe the steps of choosing a supervisor, provide elements that must be considered when developing a supervision contract, offer a template for crafting a document that will assist with assessing fidelity to one’s practice and maximize consistency and productivity in the supervision process, and detail the potential supervision dynamics in different levels of clinical collaboration. Supervision that is tailored to the BHPs level of clinical collaboration in their given practice setting can provide a structure for the supervision process.Behavioral health providers (BHPs) are trained by their respective programs and professions on the importance of communicating with other professionals around patient care, yet few are trained on how to provide collaborative care and work as part of a team. New clinical innovation models, such as integrated care, punctuate the need to further develop training methods to best equip the next generation of BHPs to work in collaborative settings. Supervision is a tool that students, interns, and new professionals can use to help them navigate new and unfamiliar territory in health care settings. This manuscript will describe the steps of choosing a supervisor, provide elements that must be considered when developing a supervision contract, offer a template for crafting a document that will assist with assessing fidelity to one’s practice and maximize consistency and productivity in the supervision process, and detail the potential supervision dynamics in different levels of clinical collaboration. Supervision that is tailored to the BHPs level of clinical collaboration in their given practice setting can provide a structure for the supervision process.