Arminée Kazanjian

Understanding Compassion Satisfaction, Compassion Fatigue and Burnout: A survey of the hospice palliative care workforce

Background: Despite the increasingly crucial role of the healthcare workforce and volunteers working in hospice and palliative care (HPC), very little is known about factors that promote or limit the positive outcomes associated with practicing compassion. Aim: The purpose of this study was to: 1) understand the complex relationships among Compassion Satisfaction, Compassion Fatigue and Burnout within the hospice and palliative care workforce and 2) explore how key practice characteristics – practice status, professional affiliation, and principal institution – interact with the measured constructs of Compassion Satisfaction, Compassion Fatigue and Burnout. Design: Self-reported measures of Compassion Satisfaction, Compassion Fatigue and Burnout, using validated scales, as well as questions to describe socio-demographic profiles and key practice characteristics were obtained. Setting/participants: A national survey of HPC workers, comprising clinical, administrative, allied health workers and volunteers, was completed. Respondents from hospital, community-based and care homes informed the results of our study (n = 630). Results: Our results indicate a significant negative correlation between Compassion Satisfaction and Burnout (r = −0.531, p < 0.001) and between Compassion Satisfaction and Compassion Fatigue (r = −0.208, p < 0.001), and a significant positive correlation between Burnout and Compassion Fatigue (r = 0.532, p < 0.001). Variations in self-reported levels of the above constructs were noted by key practice characteristics. Levels of all three constructs are significantly, but differentially, affected by type of service provided, principal institution, practice status and professional affiliation. Results indicate that health care systems could increase the prevalence of Compassion Satisfaction through both policy and institutional level programs to support HPC professionals in their jurisdictions.

Effect of the hospital nursing environment on patient mortality: a systematic review:

Objective: Research has examined the effect of the structure of health systems on health outcomes, but not how outcomes are affected by the nursing environments in hospitals. Our objective was to gather, critically appraise and synthesize all relevant primary research on the effect of the nursing environment on patient mortality. Methods: Five electronic bibliographic databases were searched from their beginning through to May/June 2001, and Medline and CINAHL were updated to March 2004, using pre-determined search strategies and inclusion criteria. Studies were included if they met pre-determined criteria, reporting primary data both on a hospital environment and patient mortality. Methodological rigour was appraised using accepted criteria for the evaluation of research protocols, including case-mix adjustment. Results: This paper focuses on 27 identified studies that investigated the impact of one or more attributes of the nursing environment on patient mortality. Nineteen studies found an association between one or more unfavourable attributes and higher mortality. There was considerable variability in attribute and outcome measures, settings and research quality across studies. This precluded statistical pooling of results. Conclusions: On balance, current evidence indicates that social and environmental attributes of hospital nursing practice have an effect on the outcomes of care. Before optimal practice settings can be designed, further research of greater rigour is needed to provide a better understanding of the mechanisms that link the nursing environment to patient outcomes.

Integrating Ethnicity and Migration As Determinants of Canadian Women's Health

Health IssueThis chapter investigates (1) the association between ethnicity and migration, as measured by length of residence in Canada, and two specific self-reported outcomes: (a) self-perceived health and (b) self-reports of chronic conditions; and (2) the extent to which these selected determinants provide an adequate portrait of the differential outcomes on Canadian womens self-perceived health and self-reports of chronic conditions. The 2000 Canadian Community Health Survey was used to assess these associations while controlling for selected determinants such as age, sex, family structure, highest level of education attained and household income.Key Findings• Recent immigrant women (2 years or less in Canada) are more likely to report poor health than Canadian-born women (OR = 0.48 CI: 0.30–0.77). Immigrant women who have been in Canada 10 years and over are more likely to report poor health than Canadian-born women (OR = 1.31 CI: 1.18–1.45).• Although immigrant women are less likely to report chronic conditions than Canadian-born women, this health advantage decreased over time in Canada (OR from 0.35 to 0.87 for 0–2 years to 10 years and above compared with Canadian born women).Data Gaps and Recommendations• Migration experience needs to be conceptualized according to the results of past studies and included as a social determinant of health above and beyond ethnicity and culture. It is expected that the upcoming longitudinal survey of immigrants will help enhance surveillance capacity in this area.• Variables need to be constructed to allow women and men to best identify themselves appropriately according to ethnic identity and number of years in the host country; some of the proposed categories used as a cultural group may simply refer to skin colour without capturing associated elements of culture, ethnicity and life experiences.

Beyond Medline: reducing bias through extended systematic review search.

OBJECTIVE To evaluate the sensitivity and precision of various extended search methods in identifying randomized controlled trials (RCTs) for systematic reviews. METHOD Prospective analysis of extended search methods (specialized databases or trial registries, reference lists, hand-searching, personal communication, and Internet) used in two systematic reviews of RCTs. The gold standard was the total number of RCTs identified by major databases (MEDLINE, EMBASE, etc.) and extended search strategies combined. Sensitivity was the proportion of all known RCTs identified by any extended search method. Precision reflected the proportion of all items uncovered by any extended search method that actually were RCTs. RESULTS The extended search identified 94 additional RCTs for the systematic reviews beyond those identified with the major databases. Specialized databases and trial registries had the highest sensitivity and precision for the lipid-lowering project (13.6% and 52.7%, respectively; p < .05) followed by scanning of reference lists (7.2% sensitivity and 41.9% precision; p <.05). Hand-searching was more effective than personal communication and Internet searching (1.7% sensitivity and 12.2% precision; p < .05). The acupuncture project had slightly different results, with the specialized databases and trial registries tied with the review of reference lists for highest sensitivity (14.2%). The precision followed the same trend as the lipid-lowering project (17.6% specialized databases; 8.3% reference lists; p < .05). A post-hoc analysis showed that 75 of the 94 RCTs were indexed in the major databases but missed by the major database search. CONCLUSIONS Extended searching identified additional RCTs for the systematic reviews beyond those found in major databases. Specialized databases and trial registries were most effective. An important number of RCTs were missed by the major database search. Timing and accuracy of indexing may explain this finding. The definitive measure, whether there is an association between the method used to uncover RCTs, the quality of the items uncovered and their impact on systematic review results, is yet to be determined.

A systematic review of craniosacral therapy: Biological plausibility, assessment reliability and clinical effectiveness

OBJECTIVES The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention. DESIGN A systematic search for and critical appraisal of research on craniosacral therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative Medicine, Scisearch and Biosis were searched from their start date to February 1999. MAIN OUTCOME MEASURES A three-dimensional evaluative framework with related appraisal criteria: (A) craniosacral interventions and health outcomes; (B) validity of craniosacral assessment; and (C) pathophysiology of the craniosacral system. RESULTS The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found. CONCLUSIONS This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.

A study of a rural community's readiness for telehealth

A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.

Oral health in long-term care - The implications of organizational culture

Abstract When an investigation designed to compare extant models of delivering oral health and dental services to the institutionalized elderly revealed that structural variables explained very little of the difference between effective and ineffective programs, secondary analytic techniques were employed to consider alternative explanations. The original study was a program evaluation based on a comparative case study of 12 long-term care (LTC) facilities. Data for each case included interviews with administrators, care providers, family members, and residents, administrative documentation, and clinical measures of oral health from the residents. The secondary analysis revealed the mechanisms through which the organizational context of each facility influenced the effectiveness of the oral health services. In addition, it revealed how administrative and leadership issues influenced the quality of care.

Mortality rates after cataract extraction.

Senile cataract may be a marker of generalized tissue aging. We examined this hypothesis using population-based linked health data. We hypothesized that any such association would diminish with increased use of cataract surgery. Mortality rates of those 50-95 years of age undergoing cataract surgery in British Columbia during either 1985 or 1989 were compared with the provincial population of comparable age who did not undergo cataract surgery during the study period. The 1985 cohort included 8,262 patients undergoing surgery and a comparison population of 804,303, and the 1989 cohort included 11,952 patients and a comparison population of 839,393. Using Cox regression, for the 1985 cohort, the hazard ratios for dying during follow-up were 3.2 for males 50-54.9 years of age [95% confidence limits (CL) = 2.0, 5.0] and 3.3 for females (95% CL = 1.9, 5.7). Hazard ratios for older age groups decreased with age. We also fit an additive risk model that produced excess mortalities that were less age dependent. In the 1985 analysis, these ranged from +7.1 per 1,000 (95% CL = +0.44, +13.76) to +20.3 (95% CL = +13.24, +27.36) for males and -17.5 (95% CL = -28.28, -6.72) to +2.0 (95% CL = -2.12, +6.12) for females. Findings for the 1989 analyses were similar, indicating that the association between cataracts and generalized aging remained constant despite a large increase in the use of cataract surgery.

Why do Chinese Canadians not Consult Mental Health Services: Health Status, Language or Culture?

Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

Review: Cultural conceptualizations of hospice palliative care: more similarities than differences

The role of culture is significant in hospice palliative care (HPC). While mainstream HPC has been well described in many Western countries, there is no conceptual clarity regarding the meaning of HPC among minority cultures and ethnicities. In this article we describe and critically appraise the findings of a literature synthesis of 15 qualitative studies regarding the conceptualization of HPC among culturally diverse populations. Three primary themes emerged regarding HPC. They highlight: (i) that HPC should attend to the physical, psychosocial and spiritual aspects of death and dying; (ii) that the ideal HPC provider demonstrates excellent knowledge and expertise about end-of-life care, and is respectful, genuine and compassionate; and (iii) that HPC should include a range of resources that alleviate the potential burdens associated with end-of-life care. The synthesis of this knowledge suggests that expectations regarding the scope of HPC across ethnic and cultural groups have more similarities than differences to the goals of mainstream HPC.