Aim
A discussion of how the construct of compassion fatigue is understood in nursing.
Background
Compassion fatigue is a topic commonly found in nursing literature.
Design
Discussion paper.
Data ...sources
The literature from 1992–2012 on compassion fatigue was examined. The literature from 1998–2012 on compassion was examined.
Implications for nursing
There are multiple and diverse understandings and definitions of what compassion fatigue is. So much so, there are equally multiple, diverse and conflicting strategies to mitigate it. To understand better what compassion fatigue is, an examination of what compassion is was undertaken. Much is written that nurses are, or should be compassionate. Compassion is an archetype of nursing. However, there is little in the nursing literature defining what compassion is. Literature on compassion outside of nursing was then examined. There is a growing body of theory and research about compassion in other disciplines. None of the multiple definitions of nurse compassion fatigue match this understanding of compassion. The tools most often used to measure nurse compassion fatigue do not appear to measure the construct of compassion.
Conclusion
To understand what nurse compassion fatigue is, we must first understand what nurse compassion is.
The construction of a positive therapeutic relationship was shown to be related with outcome in psychotherapy, but there are only a few prescriptive concepts helping the therapist to contribute to ...such a process. The present case illustrates the use of Plan Analysis (PA) and the motive‐oriented therapeutic relationship (MOTR) in the explanation of the construction of a positive therapeutic relationship. We analyze the case of Sharon, a 22‐year‐old student presenting with major depressive disorder. We present the case formulation according to PA and select Session 7 from the therapeutic process to illustrate three moments of the therapist focus on the underlying motives: (a) a first moment when the therapist presents with nonoptimal features of responding to the patient's profile, (b) a second moment when the therapist intervenes optimally, and (c) a third moment when the therapist intervenes excellently. We discuss this case from the perspective of personalizing psychotherapy.
Therapists' forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists' views and challenges with online therapy. This study ...aimed to investigate the main challenges experienced by therapists during the transition from in-person to online therapy at the beginning of the pandemic and 3 months later, and the association between these challenges and therapists' perception of the quality of the relationship with their online patients, and therapists' attitudes and views about online therapy and its efficacy at these two timepoints. As part of a large-scale international longitudinal survey, we collected data from 1,257 therapists at two timepoints: at the start of COVID-19, when many therapists switched from providing in-person therapy to online therapy, as well as 3 months later, when they had had the opportunity to adjust to the online therapy format. At both timepoints, therapists reported on perceived challenges, quality of working alliance and real relationship, attitudes toward online therapy, and their views on online therapy's efficacy compared to in-person therapy. Factor analysis of individual survey items at both timepoints identified four different types of challenges among this therapist sample: Emotional connection (feeling connected with patients, reading emotions, express or feel empathy), Distraction during sessions (therapist or patient), Patients' privacy (private space, confidentiality), and Therapists' boundaries (professional space, boundary setting). Older and more experienced therapists perceived fewer challenges in their online sessions. At baseline, all four types of challenges were associated with lower perceived quality of the therapeutic relationship (working alliance and real relationship), and more negative attitudes toward online therapy and its efficacy. After 3 months, perceived challenges with three domains - Emotional connection, Patients' privacy, and Therapists' boundaries significantly decreased - whereas challenges in the fourth domain - Distraction - increased. In our study, therapists' concerns about being able to connect with patients online appeared to be the most impactful, in that it predicted negative attitudes toward online therapy and its perceived efficacy 3 months later, above and beyond the effect of therapists' age and clinical experience. Clinical and training implications are discussed.
The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke ...rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit.
Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis.
A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it.
Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality.
IMPLICATIONS FOR REHABILITATION
Developing therapeutic relationships requires a person-centred and sometimes family/whānau-centred approach.
The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries.
Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions.
In this study, we introduce the journal issue devoted to evidence‐based responsiveness and frame it within the work of the third interdivisional APA Task Force on Evidence‐Based Relationships and ...Responsiveness. We summarize the meta‐analytic results and clinical practices on the adaptations of psychotherapy to multiple transdiagnostic characteristics of the patient, including attachment style, culture (race/ethnicity), gender identity, coping style, therapy preferences, reactance level, religion and spirituality, sexual orientation, and stages of change. We then discuss the clinical and research process of determining what works, and what does not work, for whom. The limitations of the Task Force’s work are outlined and frequently asked questions are addressed. The article closes with the Task Force’s formal conclusions and 28 recommendations and with some reflections on fitting psychotherapy to the individual client.
Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked ...to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a “digital-first” primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers’ views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.
•Digital health tools can both support and disrupt therapeutic relationships.•The meaning of digital tools for patients and providers plays an important role.•The Theory of Social Representation helps to understand construction of meaning.•Constructed meanings of technology and therapeutic relationships needs to align.
Against the backdrop of the difficult therapeutic relationship between Tony Soprano and Jennifer Melfi and its embeddedness in the series’ dramaturgy, this article explores what psychoanalysis ...accomplishes for the US TV series
(1999–2007), in particular for its perspectives on serial narratives and their reception. It analyses how select tenets of psychoanalysis (in particular, the psychoanalytic setting, countertransference, and its interminability) self-reflexively interrogate the aesthetics of serial narration and the ethical underpinnings of the audience’s attachment to the series.
The prevalence of natural menopause means that middle aged women seeking osteopathic treatment are likely to have symptoms, but it is unknown how osteopaths explore and give advice about it.
To ...explore osteopaths’ experiences of screening for symptoms of menopause and providing advice to climacteric patients.
Elements of interpretative Grounded Theory, via semi-structured interviews with a purposive sample of six experienced osteopaths and constant comparative analysis to identify themes.
Three themes emerged: Breaking the ice - describing the menopause as a sensitive topic with social, personal, and professional barriers to explore it; Personal - not so personal - revealing the influence of practitioners' personal experiences of the menopause; and Storytelling - illustrating osteopaths’ narratives about patient interactions.
The three themes combined flexibly to form partially overlapping therapeutic approaches, underpinned by participants' personal experience of the menopause and conception of osteopathy. Sharing Stories, where personal disclosure is leveraged to enhance the rapport, with links to the Communicator therapeutic approach; Telling Stories, where the absence of personal experience led to a de-personalised narrative and elements of the Treater approach; and Changing the Story, where personal experience plays no role and the focus is on patients’ empowerment (Educator approach). Further research is needed to explore findings on osteopaths without personal experience of menopause and to evaluate osteopaths’ training to address sensitive topics.
Background
“Patient‐Targeted Googling” (PTG) refers to a healthcare professional using the Internet to discover information about a patient. The present review explores PTG by psychological ...therapists. The review focused on the prevalence of PTG, how often consent is sought from the patient, and the motivations for and consequences of PTG.
Method
A narrative literature review of published PTG studies was undertaken. Potentially eligible studies were identified by searching PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, and MEDLINE. Results were screened for suitability for inclusion in the sample (n = 9). All studies were appraised for quality using a structured tool developed for this review.
Results
PTG prevalence rates ranged from 20% to 98%, with rates of non‐consent ranging from 60% to 84%. Motivations for PTG included curiosity, to gather new information and to verify existing information. Consequences of PTG included enhancing the therapist's sense of safety and causing harm to the therapeutic relationship.
Discussion
Current literature on PTG is limited and focussed largely in the United States. This review revealed no published PTG studies including UK‐based psychological therapists, as well as issues in defining and operationalising PTG. Further research is needed to understand the prevalence of PTG by UK‐based psychological therapists, as well as the motivations behind, and consequences of, PTG. This evidence base will inform the development of PTG professional guidelines and training, neither of which currently exist for therapists practising in the UK. Both would be timely given the increasing move of the therapeutic frame to the online environment due to the COVID‐19 pandemic.
With over 35 years’ experience of paediatric nursing, almost half of which she has spent in haemophilia care, Robyn reflects on the importance of taking a family-focused approach and engaging with ...parents and caregivers. She describes her experience of providing care for a family with two boys with severe haemophilia A and inhibitors, and how listening to and working closely with the parents enabled good outcomes. Robyn points to the central role of nursepatient relationship in haemophilia care but highlights the importance of ensuring that this close therapeutic relationship remains professional.
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