Susan L. Ray

Compassion Satisfaction, Compassion Fatigue, Work Life Conditions, and Burnout Among Frontline Mental Health Care Professionals

Frontline mental health care professionals (FMHPs) in a variety of roles such as nursing, social work, psychology, psychiatry, case managers and mental health workers are often required to provide ...

Unspoken phenomena: using the photovoice method to enrich phenomenological inquiry.

Photovoice is a powerful method that is gaining momentum in nursing research. As a relatively new method in nursing science, the situatedness of photovoice within or alongside various research methodologies in a single study remains in a stage of early development. The purpose of this paper is to discuss the photovoice method as a means to elicit phenomenological data when researching the lived experience. While the foundational bases of phenomenology and photovoice differ substantially, the argument presented in this paper suggests that the photovoice method can be successfully used in phenomenological inquiry provided that significant rigour checks are pursued. This includes reflecting upon the origins and understandings of both methodology and method to promote methodological congruency. Data collection and analysis approaches that contribute to phenomenological inquiry using the photovoice method in addition to rigour and ethical considerations are discussed. The use of data generated from photovoice in phenomenological inquiry may fill a void of understanding furnished by limitations of traditional phenomenological inquiry and of spoken language and can enhance understanding of the lived experience, which may not always be best understood by words alone.

Whistleblowing and Organizational Ethics

The purpose of this article is to discuss an external whistleblowing event that occurred after all internal whistleblowing through the hierarchy of the organization had failed. It is argued that an organization that does not support those that whistle blow because of violation of professional standards is indicative of a failure of organizational ethics. Several ways to build an ethics infrastructure that could reduce the need to resort to external whistleblowing are discussed. A relational ethics approach is presented as a way to eliminate the negative consequences of whistleblowing by fostering an interdependent moral community to address ethical concerns.

Cumulative Trauma, Personal and Social Resources, and Post-Traumatic Stress Symptoms Among Income-assisted Single Mothers

Data from 247 single mothers were used to partially validate a theoretical model that highlights the process through which post-traumatic stress disorder (PTSD) develops among women. Structural equation modeling was used to assess the direct and indirect relationship between cumulative trauma (CT) and mothers’ PTSD symptom severity. Additionally, we examined the meditational role played by mothers’ strains and resources and the moderating role played by mothers’ residence in an intersectionally advantaged versus disadvantaged neighborhood. A good fit was found between the hypothesized model and data. Mothers’ strains and personal resources played a significant mediating role in the relationship between CT and PTSD symptom severity. Neighborhood of residence did not moderate the CT-PTSD process. Implication for practice and treatment are discussed.

Evolution of posttraumatic stress disorder and future directions.

The knowledge that trauma can cause long-term physiological and psychological problems has been recognized for centuries. Today, such suffering would be classified as the characteristic symptoms of posttraumatic stress disorder (PTSD). Nurses in all practice settings are increasingly caring for individuals suffering from military trauma, natural disasters, and interpersonal violence such as childhood sexual, physical, and emotional abuse, intimate partner violence, and collective violence. This article discusses how the diagnosis of PTSD evolved over the course of history, limitations of the PTSD diagnostic category, and additional diagnostic categories for trauma. Implications for nursing practice and future directions for research are explored.

Canadian military transitioning to civilian life: a discussion paper.

The purpose of this discussion paper is to explore the existing literature from Canada on transitioning from military to civilian life for veterans of recent deployments. A number of topics relating to the transition experience emerged: interpersonal readjustment, emotional including mental health needs, school needs, and social needs. Implications for nursing will be discussed in terms of veterans as a cultural group and culturally competent nursing care. Recommendations for future nursing research include how well current services are meeting the needs of the younger, more recent veterans transitioning to civilian life; conducting longitudinal studies on the impact of transitioning to civilian life for veterans and their families; comparing the transition experience at an international level; developing a transition model that situates the veteran culture as the overarching framework for testing and understanding the experience of transitioning to civilian life.

Promises of peace and development: Mining and violence in Guatemala

For Indigenous peoples of Guatemala, mining is experienced within a lingering legacy of colonialism and genocide. Here, we discuss macro-level findings of a larger study, examining the lived context of a mining-affected community in Guatemala and barriers that this poses to peace. Using an anticolonial narrative methodology, guided by participatory action research principles, we interviewed 54 participants. Their accounts pointed to intersecting and ongoing forces of poverty, dispossession, gendered oppression, genocide, and global inequity were exacerbated and triggered by local mining operations. This context posed profound threats to community well-being and signals a call to action for nurses and other global actors.

Strengths Amidst Vulnerabilities: The Paradox of Resistance in a Mining-Affected Community in Guatemala

The influence of large-scale mining on the psychosocial wellbeing and mental health of diverse Indigenous communities has attracted increased attention. In previous reports, we have discussed the influence of a gold mining operation on the health of a community in the Western highlands of Guatemala. Here, we discuss the community strengths, and acts of resistance of this community, that is, community processes that promoted mental health amidst this context. Using an anti-colonial narrative methodology that incorporated participatory action research principles, we developed a research design in collaboration with community leaders and participants. Data collection involved focus groups, individual interviews and photo-sharing with 54 men and women between the ages of 18 and 67. Data analysis was guided by iterative and ongoing conversations with participants and McCormacks narrative lenses. Study findings revealed key mechanisms and sources of resistance, including a shared cultural identity, a spiritual knowing and being, ‘defending our rights, defending our territory,’ and, speaking truth to power. These overlapping strengths were identified by participants as key protective factors in facing challenges and adversity. Yet ultimately, these same strengths were often the most eroded or endangered due the influence of large-scale mining operations in the region. These community strengths and acts of resistance reveal important priorities for promoting mental health and wellbeing for populations impacted by large-scale mining operations. Mental health practitioners must attend to both the strengths and parallel vulnerabilities that may be occasioned by large-scale projects of this nature.

Trauma from a global perspective

Trauma from widespread collective violence such as genocide and ethnic cleansing has not been discussed from a global perspective. It will be argued that the Western medical model of diagnostic labeling is inadequate for understanding victims of collective violence from around the world. Phenomenology and liberation philosophy will be discussed as alternatives to understanding trauma from collective violence that move beyond the Western medical model of diagnostic labeling. The insights gained from these alternative approaches will contribute to the development of nursing education, research, and practice relevant to the health of victims of collective violence around the globe.

Hard to Swallow: A Phenomenological Exploration of the Experience of Caring for Individuals With Myotonic Dystrophy and Dysphagia.

ABSTRACT:Purpose: Myotonic dystrophy (DM1), a genetic, multisystemic disorder, is the most prevalent adult form of muscular dystrophy. Dysphagia is a common symptom that may be difficult to diagnose and treat and can be associated with increased morbidity and mortality. Preexisting cognitive impairment or apathy, both well described in the DM1 literature, may contribute to management challenges. Caregivers may become important for managing a family member’s swallowing dysfunction. Although clinicians place great importance on swallowing difficulties, it is unknown how dysphagia impacts patients and their caregivers. Therefore, the purpose of this study was to explore the experiences of caregivers living with those with DM1and dysphagia. Methods: An interpretive phenomenological approach was used to study the lived experience of six caregivers for individuals with DM1 and dysphagia. Audio-taped semistructured interviews were used for data collection, and data were analyzed using van Manen’s steps for phenomenological analysis. Findings: Despite the potential for dysphagia to cause morbidity and mortality in individuals with DM1, caregivers did not describe this as a problematic symptom. Instead, they highlighted more debilitating symptoms like fatigue or weakness and discussed the caregiving experience. Themes pertaining to participants’ lived body, lived relationality, lived time, and lived space were identified. Conclusions: Healthcare providers need to balance issues of clinical concern with those that are important for individuals and their family members. Assessments of caregiver knowledge and burden at each clinic visit may be warranted.