Stress reactions following acute situations involving moral challenges among health care professionals

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long‐term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and “others” (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long‐term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long‐term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well‐functioning Formal social support. Regarding long‐term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. Conclusion: the results largely supported the model concepts and their assumed relationships.     

Victims' Stories: A Call to Care

In her book Victims' Stories and the Advancement of Human Rights, Diana Meyers offers a careful analysis of victims' stories as a narrative genre, and she argues that stories in this genre function as a call to care: they both depict a moral void and issue a moral demand, thereby fostering the development of a culture of human rights. This article, while finding Meyers's articulation of this idea compelling, questions Meyers's account of how victims' stories do their moral work. Whereas Meyers argues that victims' stories are complete narratives, characterized by a distinctive form of closure, it suggests that the moral power of victims' stories may lie in part in their open‐endedness or lack of closure. In telling their stories, victims engage their audiences in a new moral relationship and implicitly give them a role to play in bringing about the moral (and narrative) closure they seek.     

Relating Coalition Capacity to the Adoption of Science-Based Prevention in Communities: Evidence from a Randomized Trial of Communities That Care

Coalition‐based efforts that use a science‐based approach to prevention can improve the wellbeing of community youth. This study measured several coalition capacities that are hypothesized to facilitate the adoption of a science‐based approach to prevention in communities. Using data from 12 coalitions participating in a community‐randomized trial of the prevention strategy Communities That Care (CTC), this paper describes select measurement properties of five salient coalition capacities (member substantive knowledge of prevention, member acquisition of new skills, member attitudes toward CTC, organizational linkages, and influence on organizations), as reported by coalition members, and examines the degree to which these capacities facilitated the community leader reports of the community‐wide adoption of a science‐based approach to prevention. Findings indicated that the five coalition capacities could be reliably measured using coalition member reports. Meta‐regression analyses found that CTC had a greater impact on the adoption of a science‐based prevention approach in 12 matched pairs of control and CTC communities where the CTC coalition had greater member (new skill acquisition) and organizational capacities (organizational linkages).     

Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age

BackgroundTo determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years.MethodsA prospective phase-lag study was performed at an Austrian neonatal intensive care unit (NICU). From January 2003 to December 2005 (study period of conventional care) and January 2007 to December 2009 (study period of developmental care), we enrolled all infants born in Tyrol at less than 32 weeks of gestation. During this period a total of 261 of 359 preterm infants (participation rate 72.7%) completed the follow-up visit at 2 years of age; there were 124 children in the conventional and 137 in the developmental care group. The association between developmental care and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analyzed by means of logistic regression analysis at a corrected age of 24 months.ResultsChildren in the developmental care group showed less psychomotor delay than did those in the control group (developmental care group: 16.1%, conventional care group 27.4%; adjusted odds ratio 0.37 [95% confidence interval: 0.19–0.74], P = 0.005). Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age. Regarding cognitive outcome, no significant difference was observed between these two groups.ConclusionOur data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants.     

Emotional intelligence and health‐related quality of life in institutionalised Spanish older adults

This study explores the relationship between emotional intelligence (EI) and health‐related quality of life (HRQoL) in a sample of Spanish older adults who are institutionalised in long‐term care (LTC) facilities. One hundred fifteen institutionalised individuals (47.82% women; 88.3 ± 7.9 years) from southern Spain completed a set of questionnaires that included measures of EI, health and personality. Data were analysed via hierarchical regression. After controlling for personality and sociodemographic variables, the EI dimensions, emotional comprehension and emotional facilitation, accounted for part of the variance in several HRQoL facets. These dimensions could have an important role in the HRQoL of residents in LTC. Moreover, the use of a performance measure addresses the limitations of previous studies that have relied on self‐report measures. These aspects underscore the importance of the results of this study.     

The Self‐Care of Psychologists and Mental Health Professionals: A Review and Practitioner Guide

It has been documented in the professional literature that psychologists and mental health professionals in general tend to neglect their own mental health, despite serving in a field that promotes the health and well‐being of others. Numerous empirical studies support the need for psychologists and mental health professionals to be more conscientious of the effect that stress and the nature of their work has on them. This article reviews some of the recent literature and discusses the pertinent issues at hand. A number of interventions are suggested along with tips for professionals to consider in order to function in a more productive and ethical fashion.     

Caring for the Suffering: Meeting the Ebola Crisis Responsibly

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the resources available to successfully manage them is effective palliative care. However, this could hasten death in this vulnerable population and hence, while ethically and medically justifiable, is not without social risk.     

The effects of undergarment type on the urinary continence of toddlers

There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams, & Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant.     

Motivational Predictors of Change in Oral Health: An Experimental Test of Self-Determination Theory

We tested the hypothesis that a psychosocial dental intervention formulated in terms of self-determination theory would increase patients’ perceived competence and autonomous motivation for dental care and would decrease their plaque and gingivitis over a seven month period, compared to standard dental treatment. We also tested a process model in which the intervention was expected to increase perceived dental competence and autonomous motivation, that they would be positively associated with oral health behaviors (i.e., brushing and flossing), which was expected to decrease plaque and, in turn, decrease gingivitis. We also examined whether: changes in perceived competence and autonomous motivation would mediate the effect of the intervention on dental-health behaviors; dental-health behaviors would mediate the links from changes in perceived competence and autonomous motivation to change in plaque; and change in plaque would mediate the relation of dental health behaviors to change in gingivitis. Finally, we examined the fit of the overall model with structural equation modelling. Results supported all predictions.