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.     

A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat

This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.     

Not so Sweet Revenge: Unanticipated Consequences of High-Intensity Sweeteners

While no single factor accounts for the significant increases in overweight and obesity that have emerged during the past several decades, evidence now suggests that sugars, in general, and sugar-sweetened beverages, in particular, may be especially problematic. One response to this concern has been an explosion in the availability and use of noncaloric sweeteners as replacements for sugar. While consumers have been led to believe that such substitutes are healthy, long-term epidemiological data in a number of cohorts have documented increased risk for negative outcomes like type 2 diabetes, heart disease, and stroke among users of artificial sweeteners. Experimental data from animals has provided several plausible mechanisms that could explain this counterintuitive relationship. In particular, my research has demonstrated that artificial sweeteners appear to interfere with basic learned, predictive relations between sweet tastes and post-ingestive consequences such as the delivery of energy. By interfering with these relations, artificial sweeteners inhibit anticipatory responses that normally serve to maintain physiological homeostasis, and over the long term, this interference could result in negative health effects like those seen in the human cohort studies. These data suggest that reducing the consumption of all sweeteners is advisable to promote better health.     

Quels sont les prédicteurs des comportements associés au respect des règles d’hygiène en soins infirmiers en cours de formation ?

We present a study whose aim is to analyse the predictability of behaviors associated with breaches of hygiene rules based on the constructs of the theory of planned behavior and implementation of intention. One hundred and fifty nursing students replied to a questionnaire following their theoretical training and then after returning from practical placement during which some were observed in a professional situation. The results highlighted the fact that self-reported behavior was associated with behavior observed in context with regard to the observance of rules governing hand hygiene and the decontamination of surfaces. Self-reported behavior is explained successively by behavioral control, intention and implementation of intention when the latter relates to behavioral reflexivity. These results are discussed from the point of view of nurse training practices.     

A comparison of individuals with unanswered callings to those with no calling at all

The purpose of this research was to compare the life-, job-, and health-related experiences of those who perceive an unanswered occupational calling to those who (1) are living a calling and (2) perceive no calling at all. Surveys containing measures of callings, work engagement, job involvement, career commitment, life and job satisfaction, turnover intentions, physical health and emotional well-being were administered to 378 American academics. As expected, academics with an answered occupational calling tended to report better job attitudes and domain-specific satisfaction and less withdrawal intentions than those who reported an unanswered occupational calling or no calling at all. Furthermore, those who did not have a calling to a particular vocation reported better life-, job-, and health-related outcomes than those experiencing an unanswered calling. Surprisingly, only those academics experiencing an unmet calling reported significantly poorer physical and psychological health as compared to the other two calling groups. These results are consistent with the self-determination theory, which predicts that those who are able to satisfy their basic psychological needs reap benefits in terms of psychological growth, optimal functioning, and wellbeing. The study contributes to the literature on callings by showing that having a calling is a benefit only if it is met, but can be a detriment when it is not as compared to having no calling at all.     

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.     

Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles

Increased understanding of the nature and role of intrusive imagery has contributed to the development of effective treatment protocols for some anxiety disorders. However, intrusive imagery in severe health anxiety (hypochondriasis) has been comparatively neglected. Hence, the current study investigates the prevalence, nature and content of intrusive imagery in 55 patients who met DSM-IV-TR (APA, 2000) criteria for the diagnosis of hypochondriasis. A semi-structured interview was used to assess the prevalence, nature and possible role of intrusive imagery in this disorder. Over 78% of participants reported experiencing recurrent, distressing intrusive images, the majority (72%) of which either were a memory of an earlier event or were strongly associated with a memory. The images tended to be future orientated, and were reliably categorised into four themes: i) being told ‘the bad news’ that you have a serious/life threatening-illness (6.9%), ii) suffering from a serious or life-threatening illness (34.5%), iii) death and dying due to illness (22.4%) and iv) impact of own death or serious illness on loved ones (36.2%). Participants reported responding to experiencing intrusive images by engaging in avoidance, checking, reassurance seeking, distraction and rumination. Potential treatment implications and links to maintenance cycles are considered.     

Aversive racism and medical interactions with Black patients: A field study

Medical interactions between Black patients and nonBlack physicians are usually less positive and productive than same-race interactions. We investigated the role that physician explicit and implicit biases play in shaping physician and patient reactions in racially discordant medical interactions. We hypothesized that whereas physicians’ explicit bias would predict their own reactions, physicians’ implicit bias, in combination with physician explicit (self-reported) bias, would predict patients’ reactions. Specifically, we predicted that patients would react most negatively when their physician fit the profile of an aversive racist (i.e., low explicit-high implicit bias). The hypothesis about the effects of explicit bias on physicians’ reactions was partially supported. The aversive racism hypothesis received support. Black patients had less positive reactions to medical interactions with physicians relatively low in explicit but relatively high in implicit bias than to interactions with physicians who were either: (a) low in both explicit and implicit bias, or (b) high in both explicit and implicit bias.     

A Community Psychology of Men and Masculinity: Historical and Conceptual Review

This paper introduces the special section by presenting a historical and conceptual review of theory and research on the psychology of men and masculinity and then introducing the section’s papers. Men have power because of their gender, but differ in access to power based on other individual characteristics such as social class, income, education, ethnicity, sexual orientation, or physical strength. Men typically have been studied as generic rather than gendered beings in psychology. In contrast, a gendered analysis of men highlights the ways in which men’s experience, masculinity, and behavior contribute to health and social problems and to resources commonly addressed by community psychologists. Our gendered analysis suggests ways of working with men in group, organizational, and community settings to create positive individual and social change. Crucial to this analysis is the paradox that enacting masculinity both privileges and damages men. A second paradox stems from men having power as a group over women while individual men feel powerless or victimized by women as a group. The papers in this volume illustrate key themes of our historical and conceptual review through studies of adolescent and adult men as fathers, patients, partner abusers, support group participants and community members, and through examination of the impact of their gendered identities and behavior on health, well being, and justice.