The Relationship between the Supervision Role and Compassion Fatigue and Burnout in Genetic Counseling

Many genetic counselors provide supervision to students during their career. Previous studies have shown genetic counselors, in general, are at increased risk for developing compassion fatigue. The purpose of this study was to determine if there was a difference in compassion fatigue and burnout levels in genetic counselors who currently supervise compared to genetic counselors who do not. Genetic counselors who currently practice in a clinical setting (N = 391) completed an online survey containing demographic questions, the Professional Quality of Life Scale, the State-Trait Anxiety Inventory, and questions specific to the genetic counselor’s experiences with supervision. Overall, when controlling for trait-anxiety, the supervision role by itself was not independently associated with the risk for compassion fatigue and burnout among genetic counselors. Within supervisors, however, there were several factors which were associated with this risk. Those with less supervision experience reported more secondary traumatic stress. Those supervisors reporting less confidence had decreased compassion satisfaction. Those with less experience or less confidence in their supervision role were most likely to be at increased risk for developing compassion fatigue. Training in supervision and support for dealing with compassion fatigue and burnout may be beneficial to supervisors with less experience.     

The Psychic Costs of Empathic Engagement: Personal and Demographic Predictors of Genetic Counselor Compassion Fatigue

Empathic connection with one’s patients is essential to genetic counselor clinical practice. However, repeatedly engaging with distressed patients may cause compassion fatigue, a phenomenon characterized as feeling overwhelmed by experiencing patients’ suffering. In order to extend findings of an initial qualitative study, we surveyed 222 genetic counselors about their compassion fatigue and factors that predict its occurrence. Multiple regression analysis identified seven significant predictors accounting for 53.7% of the variance in compassion fatigue. Respondents at higher risk of compassion fatigue were more likely to report being burned out, using self-criticism and giving up to manage stress, experiencing a greater variety of distressing clinical events, having larger patient caseloads, relying on religion as a coping strategy, having no children, and seeking support to manage stress. Respondents also provided critical incidents regarding their compassion fatigue and themes in these incidents are described. Practice and research recommendations are provided.     

Mindfulness Among Genetic Counselors Is Associated with Increased Empathy and Work Engagement and Decreased Burnout and Compassion Fatigue

Genetic counselors experience high rates of compassion fatigue and an elevated risk for burnout, both of which can negatively impact patient care and retention in the profession. In other healthcare professions, mindfulness training has been successfully used to address similar negative psychological sequelae and to bolster empathy, which is the foundation of our counseling work. We aimed to assess associations between mindfulness and key professional variables, including burnout, compassion fatigue, work engagement, and empathy. Data were collected via an anonymous, online survey that included validated measures of mindfulness and these key professional variables. The survey was completed by 441 genetic counselors involved in direct patient care. Half of the respondents (50.1%) reported engaging in yoga, meditation, and/or breathing exercises. Mindfulness was positively correlated with work engagement (r?=?0.24, p?<?0.001) and empathy (as measured through four subscales: perspective taking (r?=?0.15, p?=?0.002), empathic concern (r?=?0.11, p?=?0.03), fantasy (r?=???0.11, p?=?0.03) and personal distress (r?=???0.15, p?=?0.001)). Mindfulness was negatively correlated with compassion fatigue (r?=???0.48, p?<?0.001) and burnout (r?=???0.50, p?<?0.001). Given these findings, mindfulness training may be a valuable addition to graduate and continuing education for genetic counselors. The integration of mindfulness into the genetic counseling field will likely improve professional morale and well-being, while promoting workforce retention and bolstering the relational and counseling aspects of our clinical work.     

Dispositional Attachment Orientations,Contextual Variations in Attachment Security,and Compassion Fatigue Among Volunteers Working With Traumatized Individuals

In the present article, we report a series of studies examining the links between attachment orientations and compassion fatigue among volunteers working with traumatized individuals. Participants were volunteers in several trauma‐related organizations, ranging in age from 18 to 69 years. In Study 1 (N = 148), we examined associations between self‐reports of attachment insecurities and compassion fatigue. In Study 2 (N = 54), we used a diary design to assess attachment‐related differences in emotional reactions to actual helping encounters over a 2‐month period. In Study 3 (N = 108), we examined the effects of the experimental enhancement of attachment security (security priming) on reactions to a hypothetical helping encounter. As expected, attachment insecurities, either anxiety or avoidance, were associated with heightened compassion fatigue. Moreover, security priming reduced compassion fatigue in response to a hypothetical helping encounter. These findings underscore the relevance of attachment theory for understanding and preventing compassion fatigue.     

Personal factors related to compassion fatigue in health professionals

This study examines the role of some personal and professional factors in compassion fatigue among health-care professionals. Research participants included 182 (89 mental and 93 medical) health-care professionals who completed an assessment battery measuring compassion fatigue, emotion management, trait emotional intelligence, situation-specific coping strategies, and negative affect. Major findings indicate that both self-report “trait” emotional intelligence and ability-based emotion management are inversely associated with compassion fatigue; adaptive coping is inversely related to compassion fatigue; and differences exist between mental and medical professions in emotional intelligence, coping strategies, and negative affect. Furthermore, problem-focused coping appears to mediate the association between trait emotional intelligence and compassion fatigue. These findings shed light on the role of emotional factors in compassion fatigue among health-care professionals. Beyond enhancing our knowledge of practitioners' professional quality of life, the current study serves as a basis for the early identification of groups of practitioners at risk for compassion fatigue.     

Personality Traits Associated with Genetic Counselor Compassion Fatigue: The Roles of Dispositional Optimism and Locus of Control

Compassion fatigue (CMF) arises as a consequence of secondary exposure to distress and can be elevated in some health practitioners. Locus of control and dispositional optimism are aspects of personality known to influence coping style. To investigate whether these personality traits influence CMF risk, we surveyed 355 genetic counselors about their CMF, locus of control orientation, and degree of dispositional optimism. Approximately half of respondents reported they experience CMF; 26.6% had considered leaving their job due to CMF symptoms. Mixed-method analyses revealed that genetic counselors having an external locus of control and low optimism were at highest risk for CMF. Those at highest risk experienced moderate-to-high burnout, low-to-moderate compassion satisfaction, and tended to rely on religion/spirituality when coping with stress. CMF risk was not influenced by years in practice, number of genetic counselor colleagues in the workplace, or completion of graduate training in this area. Recommendations for practice and education are outlined.     

Burnout,compassion fatigue and compassion satisfaction among nurses in the context of maternal and perinatal deaths

This study investigated the prevalence and levels of burnout, compassion fatigue and compassion satisfaction among nurses with exposure to maternal and perinatal deaths. A convenience sample of 83 nurses was selected for participation from six hospitals in Limpopo province, South Africa, comprising 98% females with an age range of 21 to 62 years, and 15 to 18 mean years of experience in maternal and perinatal care. The nurses completed the Professional Quality of Life Scale (ProQOL R-IV), which is a measure of burnout, compassion fatigue and compassion satisfaction. The analysis examined the prevalence and level of burnout, compassion fatigue and compassion satisfaction among the nurses. Most of the respondents (92%) reported with moderate burnout scores, and about 67% reported with moderate to high compassion fatigue scores, whilst 82% reported with compassion satisfaction scores. Moderate levels of high burnout and compassion fatigue can co-occur with relatively high compassion satisfaction among nurses in critical-care health services.     

Compassion satisfaction,compassion fatigue,and burnout in a national sample of trauma treatment therapists

Abstract

For behavioral health professionals working with traumatized clients, continuous and prolonged exposure to the stress of working with the myriad of trauma-related stressors experienced by their clients can lead to various responses including burnout, compassion fatigue, and compassion satisfaction. The present study investigates the impact of using evidence-based practices on compassion fatigue, burnout, and compassion satisfaction in a random, national sample of self-identified trauma specialists (N=532). The 30-item Professional Quality of Life Scale (Stamm, 2005) and the 19-item Trauma Practices Questionnaire (Craig & Sprang, 2009) were included in a survey to licensed social workers and psychologists from professional membership rosters. Age and years of experience proved to be powerful predictors of only two of the three criterion variables, with younger professionals reporting higher levels of burnout and more experienced providers endorsing higher levels of compassion satisfaction. The utilization of evidence-based practices predicted statistically significant decreases in compassion fatigue and burnout, and increases in compassion satisfaction. The utility of these findings in understanding the process of trauma transmission between therapist and client as well as directions for future research are discussed.     

Resilience of Professional Counselors Following Hurricanes Katrina and Rita

Professional counselors who provided services to those affected by Hurricanes Katrina and Rita completed the K6+ (screen for severe mental illness), the Posttraumatic Growth Inventory, and the Professional Quality of Life Scale. Results indicated that participants who survived the hurricanes had higher levels of posttraumatic growth than participants who served as volunteers. Both volunteer and survivor‐volunteer participants were susceptible to compassion fatigue. To further resiliency, self‐care strategies were found to minimize burnout, compassion fatigue, and vicarious traumatization.     

Application of Yoga as a Spiritual Practice to Enhance Counselor Wellness and Effectiveness

In this article, we explore potential benefits of yoga, an ancient Indian tradition for spiritual growth and development, for counselors. Counselors use themselves as instruments to support clients and are constantly exposed to the traumatic experiences of clients, which may leave them susceptible to secondary traumatic stress or compassion fatigue (Shallcross, 2011). Yoga can help counselors not only in achieving holistic wellness but also in developing a way of being consistent with the characteristics of an effective counselor. Furthermore, yoga, as a spiritual practice, can empower counselors to embark on a spiritual journey driven by their own personal experiences.     

Balancing Genetics (Science) and Counseling (Art) in Prenatal Chromosomal Microarray Testing

Genetic counselors frequently are called upon to assist patients in understanding the implications of prenatal testing information for their pregnancies and their family’s lives. The introduction of highly sensitive testing such as chromosomal microarray has generated additional kinds of uncertainty into the prenatal period. Counselors may feel uncomfortable or inadequately prepared to engage in discussions with prospective parents who are faced with making critical, and timely, decisions about a pregnancy based on uncertain information. As highly sensitive prenatal testing becomes routine in prenatal care, counselors may be in search of approaches to prenatal counseling, as well as specific skills to approach, engage with, and help families find resolution in such challenging circumstances. To assist genetic counselors, we describe practice skills and provide language for approaching conversations with prospective parents. When clinicians regularly provide care to patients and families making life-altering decisions under conditions of significant uncertainty, discomfort is common and compassion fatigue is likely. We make recommendations directly to the genetic counselor working in reproductive and perinatal settings to enhance training and self-care and to decrease discomfort in balancing the scientific- and art- demands of genetic counseling.     

The relationship between existential attitudes and professional quality of life among nursing students

This study examined the relationship between existential attitudes and professional quality of life among a sample of South African nursing students (N = 150; mean age = 21.19, SD = 2.77; female = 90%). The student nurses completed the Life Attitudes Profile-Revised (LAP-R) and the Professional Quality of Life Scale (PROQoL). The data were analysed using the Pearson product-moment correlation and multiple regression analysis. Existential attitudes significantly predicted scores on the PROQoL. The findings suggest that existential attitudes are an essential personal resource that could serve as a potential buffer against compassion fatigue and burnout while enhancing compassion satisfaction.     

Practice variability in prenatal genetic counseling

This study demonstrated that the content of prenatal genetic counseling sessions varied from counselor to counselor and from center to center. The study was designed to examine which specific issues were included by genetic counselors in prenatal genetic counseling sessions, and to determine which factors led genetic counselors to include or exclude this information from such sessions. Data were collected by randomly surveying 200 full, master degree members of the National Society of Genetic Counselors (NSGC). Respondents provided information by deciding which of 45 specific issues they would include in a standard prenatal genetic counseling session, and which one factor from a bank of 11 factors most accurately described the reason for this decision. The results indicated that the issues included/excluded from sessions varied widely among genetic counselors. The results also indicated that Patient Education/Informed Decision Making (34.5%) played the largest role in decision making overall, with Standard at Center/Departmental Policy (17.6%), Personal Experience/Preference (12.4%), and Applicability (10.9%) serving as the next three most important reasons for including or excluding issues from prenatal genetic counseling sessions.     

Correlates of compassion fatigue and burnout in chaplains and other clergy who responded to the September 11th attacks in New York City

Participants at a June 2002 conference about the September 11th attacks were tested for compassion fatigue, compassion satisfaction, and burnout. The sample consisted of 343 clergy, including 97 chaplains. A total of 149 (43.4%) of the participants had responded as disaster-relief workers following the September 11th attacks. The number of hours clergy worked with trauma victims each week was directly related to compassion fatigue among responders and non-responders. Compassion fatigue also was positively related to the number of days that responders worked at Ground Zero, while disaster-relief work with the American Red Cross reduced compassion fatigue and burnout. Clinical Pastoral Education tended to decrease compassion fatigue and burnout and increase compassion satisfaction in both responders and non-responders. Burnout was inversely related to age in both groups.     

Clinicians' Experiences of Shared Trauma After the Shootings at Virginia Tech

This phenomenological study was designed to describe the shared trauma perspectives of 8 counselors who experienced the shootings at Virginia Tech and responded to community mental health needs. Shared trauma, vicarious traumatization, compassion fatigue, vicarious resilience, and posttraumatic growth were examined. Themes derived from interviews included changed perceptions of those who experienced shared trauma and the influence of the experiences on clinicians' work. Implications for practitioners and for counselor training are presented.     

Ethical issues in genetic counseling: A comparison of M.S. counselor and medical geneticist perspectives

New technologies available in the field of medical genetics have increased the importance of responsible ethical decision-making among genetic counselors. A 1985 national survey of M.D. and Ph.D. genetic counselors assessed ethical attitudes using case scenarios designed to simulate dilemmas faced in genetic counseling (Wertz and Fletcher, 1988b). The current study focuses on attitudes of M.S. genetic counselors using similar scenarios, allowing for effective comparisons. M.S. counselors were more willing than M.D. and Ph.D. counselors to maintain patient confidentiality when screening for Huntington's Disease and occupational diseases, and a greater number would agree to counsel patients pursuing prenatal testing for sex selection. A majority of M.S. counselors would disclose an XY karyotype to a phenotypically female patient. M.S. counselors reasoned that respect for patient autonomy and patient confidentiality justified their decisions in many cases. The importance of these principles is discussed and questioned.     

Defining the Role of Laboratory Genetic Counselor

An increasing number of genetic counselors are moving into non-clinical roles, where their primary duties do not involve direct patient contact. According to the National Society of Genetic Counselors Professional Status Survey in 2010, 23% of counselors working in non-clinical roles identified laboratory or genetic testing as their primary area of work. Using a survey, we identified 43 genetic counselors who work predominately in laboratory settings. The two primary tasks performed by participants, include acting as a customer liaison (95%) and calling out test results (88%). Nineteen participants (44.2%) also reported spending a considerable amount of time signing reports. The most prevalent areas of job satisfaction were support from laboratory directors (76.8%), autonomy (76.7%), interactions with clinicians (69.7%) and interaction with other genetics counselors (67.5%). This is the first study specifically looking at the roles of laboratory genetic counselors, which is an expanding area of genetic counseling.     

Telephoned BRCA1/2 Genetic Test Results: Prevalence, Practice, and Patient Satisfaction

While the traditional model of genetic evaluation for breast cancer risk recommended face-to-face disclosure of genetic testing results, BRCA1/2 testing results are increasingly provided by telephone. The few existing studies on telephone genetic counseling provide conflicting results about its desirability and efficacy. The current study aimed to (1) Estimate the prevalence among genetic counselors of providing BRCA1/2 genetic test results by phone (2) Assess patient satisfaction with results delivered by telephone versus in-person. A survey was sent to members of the Familial Cancer Risk Counseling Special Interest Group via the NSGC listserve and was completed by 107 individuals. Additionally, 137 patients who had received BRCA genetic testing results either by phone or in-person at UNC Chapel Hill Cancer Genetics Clinic were surveyed regarding satisfaction with the mode of their BRCA1/2 results delivery. The genetic counseling survey revealed that the majority of responding counselors (92.5%) had delivered BRCA1/2 genetic test results by telephone. Patients having received results either in person or by phone reported no difference in satisfaction. Most patients chose to receive results by phone and those given a choice of delivery mode reported significantly higher satisfaction than those who did not have a choice. Those who waited less time to receive results once they knew they were ready also reported higher satisfaction. This study found supportive results for the routine provision of BRCA1/2 genetic test results by telephone. Results suggest that test results should be delivered as swiftly as possible once available and that offering patients a choice of how to receive results is desirable. These are especially important issues as genetic testing becomes more commonplace in medicine.     

Views on Abortion: A Comparison of Female Genetic Counselors and Women from the General Population

While literature characterizing individual genetic counselors’ abortion attitudes is sparse, the National Society of Genetic Counselors takes a clear stance for reproductive autonomy. To determine genetic counselors’ views, this study compared (1) genetic counselors’ abortion attitudes to those of women from the general population and (2) genetic counselors’ professional abortion attitudes to their personal abortion attitudes. Genetic counselors were invited to complete an online survey. Response rate was 44.3% (709/1,601). Compared to women from the general population, female genetic counselors were significantly more likely to agree abortion should be an option in all cases (p < .001). Controlling for other possible confounders, regression analyses revealed that being a genetic counselor, religious service attendance and age were significantly predictive of abortion attitudes. Although the vast majority of genetic counselors agree that abortion should be available, they are significantly less likely to personally consider abortion under all circumstances presented (p < .001), and the percentage of genetic counselors who would consider terminating in the case of a severe birth defect is similar to studies of other women.