This document summarizes a qualitative meta-synthesis that explored the impact of grief on oncology nurses. The meta-synthesis analyzed research that used various terms to describe oncology nurses' grief such as compassion fatigue, burnout, grief, and stress. The analysis found commonalities between the terms in how they described emotional and physical responses to caring for patients. Based on the findings, the document proposes a definition of "oncology nurses' grief" as the emotional and physical effects of experiencing regular stressors of caring for oncology patients and end-of-life care. The definition incorporates aspects of compassion fatigue, burnout, grief, and stress as described in the literature. The meta-synthesis concludes by discussing
Hlt 362 v Exceptional Education / snaptutorial.comBaileya62
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total
NURSING STREE JHGJHS JBJHS JHBFJSH JHBHJ JHBFFHJ HJJHHBJHHDFJH JHFHJDS FGSDF GDFGDFG DFGDSFG DFGDFSG DFGDSFG DSFG DFG DFG DFG DFG DSG SDFG DFG D FGD SG DFG DG ETS GFDF GDSF G SDGFDF GD FG G SDG SD FGH DFG SD GDSF G DFS GDS G DFGTHYTR ERT ER Y ERT ER T EY ERT WERWE Y ERR Y ERR T ERY ET Y ETY ERT ETY RT Y TY TR RTY E RTER T E TE RT ETY R T ER T ER TR ER RT T TY YT RT Y TY EY YT T ERY T Y RTY ER Y ER
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
Hlt 362 v Effective Communication / snaptutorial.comHarrisGeorg26
Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.
Hlt 362 v Exceptional Education / snaptutorial.comBaileya62
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total
NURSING STREE JHGJHS JBJHS JHBFJSH JHBHJ JHBFFHJ HJJHHBJHHDFJH JHFHJDS FGSDF GDFGDFG DFGDSFG DFGDFSG DFGDSFG DSFG DFG DFG DFG DFG DSG SDFG DFG D FGD SG DFG DG ETS GFDF GDSF G SDGFDF GD FG G SDG SD FGH DFG SD GDSF G DFS GDS G DFGTHYTR ERT ER Y ERT ER T EY ERT WERWE Y ERR Y ERR T ERY ET Y ETY ERT ETY RT Y TY TR RTY E RTER T E TE RT ETY R T ER T ER TR ER RT T TY YT RT Y TY EY YT T ERY T Y RTY ER Y ER
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
Hlt 362 v Effective Communication / snaptutorial.comHarrisGeorg26
Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.
Hlt 362 v Enhance teaching-snaptutorial.comrobertleew24
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
Hlt 362 v Believe Possibilities / snaptutorial.comStokesCope25
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.
As Hall says; “To look at and listen to self is often too difficult without the help of a significant figure (nurturer) who has learned how to hold up a mirror and sounding board to invite the behaver to look and listen to himself. If he accepts the invitation, he will explore the concerns in his acts and as he listens to his exploration through the reflection of the nurse, he may uncover in sequence his difficulties, the problem area, his problem, and eventually the threat which is dictating his out-of-control behavior.”
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Job Satisfaction and Perceived Self-Efficacy among Greek Nursesinventionjournals
Aim: The aim of this study is to evaluate job satisfaction and perceived self-efficacy of nurses working in a general hospital in Greece. Background: Most people spend a considerable part of their lifetime working. Work and social life form a whole by being interconnected and also give each other meaning. For this reason, job satisfaction becomes important for all professions. Methods: A quantitative, cross-sectional, and descriptive research design was used in this study. Data were collected using the Minnesota Job Satisfaction Scale, the General Perceived Self-efficacy Scale and a demographic questionnaire. Results: The study sample was composed of 101 participants. We found that a positive significant relationship between job satisfaction, liking one’s job, salary, and choosing the department to work where one works. There was no significant difference between perceived self-efficacy and job satisfaction in our sample of Greek nurses. Conclusion: Further studies should be carried out in different countries with larger samples and different nursing specialties to shed light on nurses’ job satisfaction. Implications for nursing management: The obtained findings show that nursing managers should try to provide these factors related to working conditions in order to improve job satisfaction.
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
Hlt 362 v Enhance teaching-snaptutorial.comrobertleew24
For more classes visit
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Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
Hlt 362 v Believe Possibilities / snaptutorial.comStokesCope25
For more classes visit
www.snaptutorial.com
Exercise 6
What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.
As Hall says; “To look at and listen to self is often too difficult without the help of a significant figure (nurturer) who has learned how to hold up a mirror and sounding board to invite the behaver to look and listen to himself. If he accepts the invitation, he will explore the concerns in his acts and as he listens to his exploration through the reflection of the nurse, he may uncover in sequence his difficulties, the problem area, his problem, and eventually the threat which is dictating his out-of-control behavior.”
The original validation of the CORS for kids and the ORS for adolescents. Allowed the benefits of client based outcome feedback to expand to youth and family and paved the way to the current RCT with kids in the schools.
Job Satisfaction and Perceived Self-Efficacy among Greek Nursesinventionjournals
Aim: The aim of this study is to evaluate job satisfaction and perceived self-efficacy of nurses working in a general hospital in Greece. Background: Most people spend a considerable part of their lifetime working. Work and social life form a whole by being interconnected and also give each other meaning. For this reason, job satisfaction becomes important for all professions. Methods: A quantitative, cross-sectional, and descriptive research design was used in this study. Data were collected using the Minnesota Job Satisfaction Scale, the General Perceived Self-efficacy Scale and a demographic questionnaire. Results: The study sample was composed of 101 participants. We found that a positive significant relationship between job satisfaction, liking one’s job, salary, and choosing the department to work where one works. There was no significant difference between perceived self-efficacy and job satisfaction in our sample of Greek nurses. Conclusion: Further studies should be carried out in different countries with larger samples and different nursing specialties to shed light on nurses’ job satisfaction. Implications for nursing management: The obtained findings show that nursing managers should try to provide these factors related to working conditions in order to improve job satisfaction.
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
Rationale and Standards of Evidence in Evidence-Based Practice.docxmakdul
Rationale and Standards of Evidence in Evidence-Based Practice
OLIVER C. MUDFORD, ROB MCNEILL, LISA WALTON
AND KATRINA J. PHILLIPS
What is the purpose of collecting evidence to inform clinical practice in psychology concerning the effects of psychological or other interventions? To quote Paul’s (1967) article that has been cited 330 times before November 4, 2008, it is to determine the answer to the question: “What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances?” (p. 111). Another answer is pitched at a systemic level, rather than concerning individuals. That is, research evidence can inform health-care professionals and consumers about psychological and behavioral interventions that are more effective than pharmacological treatments, and to improve the overall quality and cost-effectiveness of psychological health service provision (American Psychological Association [APA] Presidential Task Force on Evidence-Based Practice, 2006). The most general answer is that research evidence can be used to improve outcomes for clients, service providers, and society in general. The debate about what counts as evidence of effectiveness in answering this question has attracted considerable controversy (Goodheart, Kazdin, & Sternberg, 2006; Norcross, Beutler, & Levant, 2005). At one end of a spectrum, evidence from research on psychological treatments can be emphasized. Research-oriented psychologists have promoted the importance of scientific evidence in the concept of empirically supported treatment. Empirically supported treatments (ESTs) are those that have been sufficiently subjected to scientific research and have been shown to produce beneficial effects in wellcontrolled studies (i.e., efficacious), in more natural clinical environments (i.e., effective), and are the most cost-effective (i.e., efficient) (Chambless & Hollon, 1998). The effective and efficient criteria of Chambless and Hollon (1998) have been amalgamated under the term “clinical utility” (APA Presidential Task Force on Evidence-Based Practice, 2006; Barlow, Levitt, & Bufka, 1999). At the other end of the spectrum are psychologists who value clinical expertise as the source of evidence more highly, and they can rate subjective impressions and skills acquired in practice as providing personal evidence for guiding treatment (Hunsberger, 2007). Kazdin (2008) has asserted that the schism between clinical researchers and practitioners on the issue of evidence is deepening. Part of the problem, which suggests at least part of the solution, is that research had concentrated on empirical evidence of treatment efficacy, but more needs c01 20 April 2012; 12:43:29 3 Hersen, Michel, and Peter Sturmey. Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders, John Wiley & Sons, Incorporated, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ashford-ebooks/detail.action?docID= ...
Cognitive conflicts in major depression: Between desired change and personal ...Guillem Feixas
Article in British Journal of Clinical Psychology (early view). Abstract:
Objectives
The notion of intra-psychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma, and on a new way of identifying these conflicts by means of the repertory grid technique. Our aim is to explore the relevance of cognitive conflicts among depressive patients.
Design
Comparison between persons with a diagnosis of major depressive disorder and community controls.
Methods
161 patients with major depression and 110 non-depressed participants were assessed for presence of implicative dilemmas and level of symptom severity. The content of these cognitive conflicts was also analysed.
Results
Repertory grid analysis indicated conflict (presence of implicative dilemma/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of implicative dilemmas per person was higher in the depression group.
In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with implicative dilemmas presented lower levels of global functioning and a more frequent history of suicide attempts.
Conclusions
Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics.
Practitioner Points
• Internal conflicts have been postulated in clinical psychology for a long time but there is little evidence about its relevance due to the lack of methods to measure them.
• We developed a method for identifying conflicts using the Repertory Grid Technique.
• Depressive patients have higher presence and number of conflicts than controls.
• Conflicts (implicative dilemmas) can be a new target for intervention in depression.
Cautions/Limitations
• A cross-sectional design precluded causal conclusions.
• The role of implicative dilemmas in the causation or maintenance of depression cannot be ascertained from this study.
EMPIRICAL STUDYThe meaning of learning to live with medica.docxSALU18
EMPIRICAL STUDY
The meaning of learning to live with medically
unexplained symptoms as narrated by patients in primary
care: A phenomenological�hermeneutic study
EVA LIDÉN, PhD1, ELISABETH BJÖRK-BRÄMBERG, PhD2 &
STAFFAN SVENSSON, MD3
1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2Institute
of Environmental Medicine, Karolinska Institutet, Solna, Sweden, and 3Angered Family Medicine Unit, Angered, Sweden
Abstract
Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a
large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical
perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person
with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of
learning to live with MUS as narrated by patients in primary health-care settings.
Methods: A phenomenological�hermeneutic method was used. Narrative interviews were performed with ten patients
suffering from MUS aged 24�61 years. Data were analysed in three steps: naive reading, structural analysis, and
comprehensive understanding.
Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms
overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining
insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of
oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky’s theory of sense
of coherence and Kelly’s personal construct theory. Possibilities and obstacles, on an individual as well as a structural level,
for promoting patients’ capacity and learning were illuminated.
Conclusions: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and
interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this
reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged
as a conventional and necessary care activity.
Key words: MUS, primary care, person centred care, phenomenological-hermeneutics
(Accepted: 19 March 2015; Published: 16 April 2015)
Medically unexplained symptoms (MUS) is a condi-
tion that affects a large but heterogeneous group
of people. The health services have so far been
unsuccessful in addressing the healthcare needs of
these people, partly because of outdated theories and
diagnostic systems that fail to encompass the com-
plexity of the patients’ health problems (Fink &
Rosendal, 2008). The lack of a medical explanation
and cure leaves patients and healthcare professionals
in a ...
1Instructions for completing Critique Conceptual NursinEttaBenton28
1
Instructions for completing Critique: Conceptual Nursing Framework
The following is a template for you to use as you complete the assignment. Table 1 (Nursing Paradigms, Features, and Conceptual Frameworks) includes an overview of features of the three Nursing Paradigms: Particulate-Deterministic; Interactive-Integrative; and Unitary-Transformative (Fawcett, 2005). Select nursing theories and models, referred to as “Conceptual Frameworks,” are identified.
Of the conceptual frameworks listed in Table 1, your group should select 2 to further explore. You may use your Alligood text and/or other available eBooks on nursing theorists. These texts have reference lists that are helpful as well, if you’d like to dig deeper in understanding a particular conceptual framework. Several nurse theorists even have their own websites!
The 2 conceptual frameworks your group chooses are your choice. You could consider selecting at least one from each nursing paradigm. Or, perhaps you personally and professionally identify strongly with one of the nursing paradigms. Each is like a “lens,” offering a certain way of viewing nursing phenomena. Chances are you already view nursing (and the world, in general) according to one of the three nursing paradigms but just didn’t have a name for it…until now!
Complete Table 2 (Selected Conceptual Frameworks: Basic Assumptions and Concepts Defined), providing a brief summary of basic assumptions and how concepts are defined for each of the 2 conceptual frameworks. From these 2 conceptual frameworks, select 1 conceptual framework from Table 2 and complete Table 3 (Selected Conceptual Framework: Conceptual Framework Evaluation Criteria Applied). The 5 criteria in Table 3 are to be used to evaluate and critique your selected conceptual framework. The criteria are also presented in Week 3: Presentations, “Theory Evaluation Criteria.” Explain your answers to the questions posed in the critique, providing rationales and examples (i.e., provide more than “yes” or “no” in your responses).
Provide a reference list of the resources you used to complete this assignment.
At the end, please provide a brief summary of each group member’s contributions to this assignment. In objective terms, specify who did what to make the group work possible and create this assignment. As a collaborative assignment for which only one document is submitted per group, everyone identified in this document should be in agreement with not only the content presented in the critique but also with the summary of contributions.
Table 1: Nursing Paradigms, Features, and Conceptual Frameworks
Nursing
Paradigm
Particulate-Deterministic
Interactive-Integrative
Unitary-Transformative
Features
· Bio-psycho-social-cultural-spiritual being
· Interacting with the environment
· Reducible into parts
· Causal relationships
· Health-Illness decided by societal norms
· Promote and maintain health and prevent disease
· Diagnosis and treat human responses t ...
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxglendar3
Running Head: MUNCHAUSEN SYNDROME
Munchausen Syndrome
Krystina Joseph
Columbia College
Munchausen Syndrome Article Review
Introduction
The Munchausen Syndrome Article explains about the Munchausen Syndrome, which is a rare fictitious disorder which involves the frequent hospitalization together with an intentional display of signs of sickness and pathological lying. In this regards, the management needs the security history taking with collaboration with the sound clinical processes which entails organicity exclusion in addressing the psychological problems. It is worth noting that a case which is presented having unusual symptoms of same dimensions are as well discussed. The case in this regards brings the finer nuances in the assessment of the entity (Prakash., et al 2014).
Research Question
Based on the abstract of the article, it can be denoted that the research question of the article is the need to understand more on the Munchausen Syndrome as well as the symptoms and therefore the need to ensure that such issues are solved by having a sound clinical process to handle the problem. The problem for the case as well was to find out what caused the 19-year-old housewife to vomit pink substance.
Findings
The findings depict that the 19-year-old housewife was suffering from a factitious disorder, also termed as the Munchausen syndrome. The psychometry performed also showed that there is an elevation of scales of anxiety together with hysteria. Consequently, being managed in an empathetic as well as non-confrontational manner, the psychotherapy was intended to improve the positive coping abilities while at the same time improving the interpersonal relationships which had been imparted (Prakash., et al 2014).
Research Methods Used
The methods used involved observations and clinical assessments. Observations were done by checking regularly the presence of the bloodstained vomits as well as the asthenia and any forms of skin allergy. This was carried out to ensure that the patient had no issues. The observations, as well as little conversation, showed that there were no cases of psychiatric illnesses for the patient in the past. Further, the assessment entails involves the systematic examinations which were performed within the normal limit. The psychiatric evaluation was performed together with ward observations which were intended at revealing the comfortability of the patient while in the hospital (Prakash., et al 2014).
The credibility of the Source of Information
To know the credibility of sources, the authors are scrutinized where their qualifications and their areas of experience assessed to understand whether the information provided is related to the topic at hand. For this article, it can be denoted that all the information provided is credible. This is because all the four authors who contributed to the article have sufficient skills and knowledge pertaining to health-related disorders, and thus, their pieces of information.
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxtodd581
Running Head: MUNCHAUSEN SYNDROME
Munchausen Syndrome
Krystina Joseph
Columbia College
Munchausen Syndrome Article Review
Introduction
The Munchausen Syndrome Article explains about the Munchausen Syndrome, which is a rare fictitious disorder which involves the frequent hospitalization together with an intentional display of signs of sickness and pathological lying. In this regards, the management needs the security history taking with collaboration with the sound clinical processes which entails organicity exclusion in addressing the psychological problems. It is worth noting that a case which is presented having unusual symptoms of same dimensions are as well discussed. The case in this regards brings the finer nuances in the assessment of the entity (Prakash., et al 2014).
Research Question
Based on the abstract of the article, it can be denoted that the research question of the article is the need to understand more on the Munchausen Syndrome as well as the symptoms and therefore the need to ensure that such issues are solved by having a sound clinical process to handle the problem. The problem for the case as well was to find out what caused the 19-year-old housewife to vomit pink substance.
Findings
The findings depict that the 19-year-old housewife was suffering from a factitious disorder, also termed as the Munchausen syndrome. The psychometry performed also showed that there is an elevation of scales of anxiety together with hysteria. Consequently, being managed in an empathetic as well as non-confrontational manner, the psychotherapy was intended to improve the positive coping abilities while at the same time improving the interpersonal relationships which had been imparted (Prakash., et al 2014).
Research Methods Used
The methods used involved observations and clinical assessments. Observations were done by checking regularly the presence of the bloodstained vomits as well as the asthenia and any forms of skin allergy. This was carried out to ensure that the patient had no issues. The observations, as well as little conversation, showed that there were no cases of psychiatric illnesses for the patient in the past. Further, the assessment entails involves the systematic examinations which were performed within the normal limit. The psychiatric evaluation was performed together with ward observations which were intended at revealing the comfortability of the patient while in the hospital (Prakash., et al 2014).
The credibility of the Source of Information
To know the credibility of sources, the authors are scrutinized where their qualifications and their areas of experience assessed to understand whether the information provided is related to the topic at hand. For this article, it can be denoted that all the information provided is credible. This is because all the four authors who contributed to the article have sufficient skills and knowledge pertaining to health-related disorders, and thus, their pieces of information.
Counselling Psychology QuarterlyVol. 24, No. 1, March 2011, .docxvoversbyobersby
Counselling Psychology Quarterly
Vol. 24, No. 1, March 2011, 43–53
How special are the specialties? Workplace settings in counseling
and clinical psychology in the United States
Greg J. Neimeyer
a*, Jennifer M. Taylor
a
, Douglas M. Wear
b
and
Aysenur Buyukgoze-Kavas
c
a
Department of Psychology, University of Florida, P.O. Box 112250, Gainesville, FL
32611, USA;
b
Psychology and Community Counseling Clinic, Antioch University Seattle,
Seattle, WA 98121, USA;
c
Department of Educational Sciences, Division of Psychological
Counseling and Guidance, Middle East Technical University, Ankara, Turkey
(Received 1 February 2010; final version received 18 February 2011)
How special are the specialties? Although clinical and counseling psychol-
ogy each have distinctive origins, past research suggests their potential
convergence across time. In a survey of 5666 clinical and counseling
psychologists, the similarities and differences between their workplace
settings were examined during early-, mid-, and late-career phases to
explore the distinctiveness of the two specialties. Overall, clinical and
counseling psychologists reported markedly similar workplace settings.
However, some significant differences remained; a greater proportion of
counseling psychologists reported working in counseling centers, while a
greater proportion of clinical psychologists reported working in medical
settings. In addition, during late-career, substantially more counseling and
clinical psychologists worked in independent practice contexts than in
community mental health centers, medical settings, academia, or university
counseling centers. Findings are discussed in relation to the ongoing
distinctiveness of the two specialties and the implications of this for training
and service in the field of professional psychology.
Keywords: clinical psychology; counseling psychology; workplace settings
Introduction
Recognized as distinct specialties by the American Psychological Association,
clinical and counseling psychology each have distinct histories, intersecting appli-
cations, and longstanding concerns regarding their continuing, or diminishing,
differences. This article explores these issues and examines the contemporary
similarities and differences between these two specialties as reflected in their
workplace settings. Workplace settings are examined at early, mid, and late career
in order to determine whether differences vary by cohort in a way that might reflect
either on their enduring or diminishing differences over time.
Enduring or diminishing differences?
Historically, the specialties of clinical and counseling psychology have developed
from different origins and formed distinctly different trajectories as a result
*Corresponding author. Email: [email protected]
ISSN 0951–5070 print/ISSN 1469–3674 online
� 2011 Taylor & Francis
DOI: 10.1080/09515070.2011.558343
http://www.informaworld.com
(Munley, Duncan, McDonnell, & Sauer, 2004). Clinical psych.
2. Read the case study entitled You be the Ethicist, presented at .docxRAJU852744
2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
YOU BE THE ETHICIST Until recently, Tyrell Dueck was a normal eighth-grader in Canada, hoping that his favorite team would win the Stanley Cup for the third time. Then, early in the school year, he slipped climbing out of the shower and discovered a lump on his leg. He was then diagnosed with bone cancer. After receiving two rounds of chemotherapy and being told that further therapy would mean the amputation of his leg, he announced that he wanted therapy stopped. He and his parents, devout fundamentalist Christians, decided to leave his health in God’s hands and seek alternative therapy. The decision sparked a court battle between his parents, who supported Tyrell’s decision, and the health care team, who sought to compel continued medical treatment and the planned amputation. The battle ultimately ended when doctors said that his cancer had spread to his lungs and that there was little more that could be done for Tyrell.
ETHICAL QUESTIONS 1. What are the compelling rights that this case addresses? 2. Whose rights should take precedence? 3. Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? 4. How would you have decided the outcome if his disease state have not intervened?
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues in Nursing (Legal Issues in Nursing ( Guido)) (p. 41). Pearson Education. Kindle Edition.
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
• What is the problem? • Where is the process? • How many are affected? • What possible solutions could be proposed? • What are the ethical arguments involved? • At what level is the problem most effectively addressed? • Who is in a position to make policy decisions? • What are the obstacles to policy interventions? • What resources are ava.
2. Read the case study entitled You be the Ethicist, presented at .docxlorainedeserre
2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
YOU BE THE ETHICIST Until recently, Tyrell Dueck was a normal eighth-grader in Canada, hoping that his favorite team would win the Stanley Cup for the third time. Then, early in the school year, he slipped climbing out of the shower and discovered a lump on his leg. He was then diagnosed with bone cancer. After receiving two rounds of chemotherapy and being told that further therapy would mean the amputation of his leg, he announced that he wanted therapy stopped. He and his parents, devout fundamentalist Christians, decided to leave his health in God’s hands and seek alternative therapy. The decision sparked a court battle between his parents, who supported Tyrell’s decision, and the health care team, who sought to compel continued medical treatment and the planned amputation. The battle ultimately ended when doctors said that his cancer had spread to his lungs and that there was little more that could be done for Tyrell.
ETHICAL QUESTIONS 1. What are the compelling rights that this case addresses? 2. Whose rights should take precedence? 3. Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? 4. How would you have decided the outcome if his disease state have not intervened?
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues in Nursing (Legal Issues in Nursing ( Guido)) (p. 41). Pearson Education. Kindle Edition.
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
• What is the problem? • Where is the process? • How many are affected? • What possible solutions could be proposed? • What are the ethical arguments involved? • At what level is the problem most effectively addressed? • Who is in a position to make policy decisions? • What are the obstacles to policy interventions? • What resources are ava ...
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Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
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While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
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2. Nurses in the oncology specialty have to deal with death and
dying on a daily basis.
Medland et al. (2004) described stressors specific to oncology
as including:
administering complex treatments
communicating with patients and families about treatment
options
treatment failure
dealing with death
ethical issues
decision-making
interdisciplinary conflicts and complicated discharges
Background
3. Wenzel et al. (2011) found daily activities of oncology
nurses consisted of a large workload with little time for
reflection and also reported that coworker support and
the sharing of similar experiences reduced stress.
Aycock and Boyle (2009) identified the close
interpersonal contact between patients and oncology
nurses can “result in physical, emotional social and
spiritual adversity” for these nurses (p. 183).
It was the variety of ways grief had been described in the
literature, as well as the potential career impact that grief
can have upon nurses – particularly oncology nurses – that
led me to want to explore the impact that grief had on my
own practice.
Background
4. Self-Study
As an oncology nurse I cared for patients who were newly
diagnosed with cancer, and often followed these same
individuals through to death
Some of these deaths left me with a profound sense of grief with
little to no support offered in the workplace
In 2013 conducted a self-study to investigated my own feelings of
grief using journaling of my experiences with grief over a 14-
week period
Findings included: sadness and grief were the most common
feelings reported, but there were many others that appeared in
the data (e.g., fatigue, frustration, anger). Rarely was there
opportunity to communicate these feelings with coworkers
5. Thesis Topic Origin
Originally planned to conduct a case study to further explore
the topic further (i.e., an extension of my self-study)
After consultation with my advisor, I discovered that while
there was research available on grief, nurses’ grief, and
even oncology nurses’ grief; there was a disconnect in the
way that research was presented
There appeared to be little overlap or cross referencing of
the many different terms that were so closely related
Essentially, because researchers were using numerous
terms that relate to nurses’ grief, in many instances they
seem to fail to build upon each other’s work
6. Literature Review
Different types of grief:
Acute – Considered the normal reaction to grief, lasting less than six months
(Holland Neimeyer, Boelen, & Prigerson, 2009)
Complicated – Prolonged or chronic grieving lasting six months or longer
(Prigerson & Jacobs, 2001)
Pathological – Severe functional impairment, lasting six months or longer
(Dodd & Guerin, 2009)
7. Literature Review
Terms similar to the concept of nurses’ grief include: Bereavement,
chronic compounded grief, cumulative grief, and disenfranchised grief.
One of the factors that each of these terms has in common is time, mainly
that there is not enough time provided for nurses to process events in a
therapeutic fashion and that lack of processing can lead to negative
consequences for the nurse.
Terms referring to nurses’ reactions to grief include: Burnout,
compassion fatigue, compulsive sensitivity, moral distress, secondary
traumatic stress disorder, stress of conscious, and vicarious traumatization
These terms emphasize the negative aspects; high stress, negative
feelings, challenging morals, a gradual worsening with an impact that
affects individuals both professionally and personally
8. Research Questions
1. In comparing and contrasting the definitions for various
terms related to oncology nurses’ grief, what are the
commonalities and differences between these terms?
2. Based on the outcome of this study, how could oncology
nurses’ grief be conceptualized in a manner that
incorporates the current varying terms and definitions?
To answer these questions a qualitative meta-analysis was
been selected as an appropriate methodology.
9. Qualitative Meta-Synthesis
Appropriate approach to examine the proposed research questions
because its purpose is to synthesis research findings into an
explanatory, interpretative product (Schreiber, Crooks, & Stern,
1997).
Can “combine the evidence of multiple studies regarding a
specific… problem to inform clinical practice and are the method of
choice for evidence-based practice initiatives” (Whittemore & Knafl,
2005, p. 547).
In this instance the specific problem is the need for a better
understanding of the various terms used to describe nurses’ grief
and nurses’ reactions to grief as well as to compare and contrast
these terms to determine commonalities and differences.
The goal is an examination of how oncology nurses’ grief resulting
from patient death or serious changes in the condition of patients
they are caring for is described in the literature.
10. Methodological Framework
Whittmore and Knalf (2005) suggested the following five
stages:
1. Problem Identification
2. Literature Search
3. Data Evaluation
4. Data Analysis
5. Presentation
11. Data Evaluation
Evaluating and interpreting quality of sources, literature was included
that added to the understanding diversity of nurses’ grief.
Inclusion –The data was be generated from the following databases:
ProQuest, Nursing & Allied Health Source, PubMed, CINAHL,
PsycInfo, and open access resources available through and Google
Scholar. More specifically inclusion criteria was limited to journal
articles directly related to oncology nursing.
Exclusion – Articles that deal with the grief experienced by nurses in
specialties outside of oncology, the nurses’ family,
physicians/doctors, other members of the health care team, patients,
and patient’s families. The exclusion criteria also included data in the
form of government documents, industry reports, conference papers
and presentations, dissertations and theses, and books.
12. Data search results by year
Total First
review
Second
review
Third
review
Final
review
2014 4430 23 7 5 4
2013 4490 23 4 4 3
2012 4530 22 8 6 6
2011 4420 12 7 6 5
2010 3900 15 2 1 1
2009 3590 12 4 4 4
2008 3660 10 3 4 3
2007 3110 2 0 1 1
2006 2750 5 1 1 1
2005 2620 1 0 0 0
13. Data Analysis
Data were coded and placed in categories, then
interpreted. The goal was to have a thorough and
unbiased interpretation of the resources and synthesis
of evidence. In this stage, data were reduced,
displayed, compared, conclusions drawn, and then
verified.
Reference Term Syndrome/Eff
ect
Descriptors Study’s
Findings
14. Results & Discussion
1. In comparing and contrasting the definitions for various
terms related to oncology nurses’ grief, what are the
commonalities and differences between these terms?
2. Based on the outcome of this study, how could oncology
nurses’ grief be conceptualized in a manner that
incorporates the current varying terms and definitions?
15. Terms Related to Grief
Term or Concept Number of occurrences
Burnout 21
Compassion fatigue 15
Grief 7
Stress 5
Bereavement / Vicarious traumatization 4
Secondary traumatic stress disorder / Moral
distress
3
Cumulative loss / Cumulative grief / Loss
and grief
2
Emotional exhaustion / Burnout syndrome /
Compassion overload / Chronic burnout /
Chronic compounded grief /Chronic stress
/Nurses grief
1
16. Single Most Dominant or Focus
Term in Articles Used as Data
Dominant or focus term Number of occurrences
Compassion Fatigue 7
Burnout 6
Grief 5
Stress 4
Cumulative Grief 2
Loss and grief / Emotional labour /
Vicarious traumatization / Nurses
grief
1
17. Compassion Fatigue
Seven articles related to compassion fatigue used similar descriptors.
For example, ‘emotional’ or ‘psychological,’ were often used at the
beginning or end of other words, to further qualify the mental aspect
of the effect of compassion fatigue. For instance, Fetter (2012)
referred to emotional distress, while Wenzel et al. (2011) described it
as psychological consequences.
Most commonly associated with the death or serious changes in the
condition of the patient.
Aycock and Boyle (2009) stated that compassion fatigue was the term
that “most closely captures all the elements” of trying to conceptualize
the experiences of oncology nurses as related to frequent exposure to
death and grief (p. 184).
Occurs when patients die, and the feelings of grief and bereavement
are experienced by nurses. In these situations nurses required
interventions to assist with managing situations and feelings (Wenzel
et al., 2011).
18. Burnout
Six articles in the data depicted burnout as the term of focus.
High workloads and lack of support were found to be the most
prominent factors contributing to burnout (Emold et al., 2011).
Another contributor to burnout for oncology nurses’ was close
nurse-patient relationships. In order to reduce this particular cause
of burnout, this strain must be recognized and nurses need to be
made to feel more supported (Davis et al., 2013).
Problems with having enough staff and high work demands
contribute to burnout, and the reduction of these barriers would
help decrease the occurrence of burnout (Edmonds et al., 2011).
19. Grief
All four pieces of literature that used grief as the term of focus used
descriptive phrases such as emotional reactions (Rice, Bennett, &
Billingsley, 2014), physical manifestations (Rice et al., 2014), grieving
(Hildebrandt, 2012; Rice et al., 2014), stress (Caton & Klemm, 2006;
Macpherson, 2008), and anxiety (Caton & Klemm, 2006).
Grief has been most recently described as the intense emotional
reaction nurses have to patient deaths that they may ignore or hide
because of ongoing work responsibilities (Rice et al., 2014).
Three of the four articles using the term grief specifically referred to
death and end of life as the grief causing agents (Hildebrandt, 2012;
Macpherson, 2008; Rice et al., 2014).
Nurses cannot stop their daily work to grieve one patient when there
are four or five others they are responsible for. As a consequence,
grief has been, and continues to be, a focus of attention for oncology
nurses and is often described in association with burnout and with
leaving the specialty (Caton & Klemm, 2006; Macpherson, 2008).
20. Stress
Four pieces of the research data used stress as the term of focus to
examine aspects of grief in oncology nurses with a focus on interventions
to prevent or minimize grief.
It was more difficult to narrow down the author’s term of focus, as each
article used many of the aforementioned terms (e.g., compassion fatigue,
burnout, vicarious traumatization, and grief).
Sabo (2008) stated that there was a need to examine the type of stress
oncology nurses endured to help better understand conditions such as
compassion fatigue and vicarious traumatization.
Hecktman (2012) stated a variety of stress prevention and management
interventions should be used to decrease stress in the oncology
workplace.
.
21. Results & Discussion
1. In comparing and contrasting the definitions for various
terms related to oncology nurses’ grief, what are the
commonalities and differences between these terms?
2. Based on the outcome of this study, how could oncology
nurses’ grief be conceptualized in a manner that
incorporates the current varying terms and definitions?
22.
23. Proposed Definition of
Oncology Nurses Grief
An all encompassing term that describes
the emotional and physical effects
experiencing various stressors on a regular
basis has on oncology nurses. These
stressors include caring for the oncology
patients on a frequent basis, as well as
care at the end of life.
24. Proposed Definition of
Oncology Nurses Grief
Compassion fatigue: Bush (2009), Joinson (1992), and Perry
et al. (2011) all identified oncology nursing’s unique ‘stressors’
Burnout: Maslach & Jackson (1981) and Grunfeld et al. (2000)
used the terms emotion and stress in their descriptions of
burnout
Grief: Parkes (1998), Rice et al. (2014), and Hildebrandt
(2012) described as emotional response or reaction to loss,
reactions to feelings and stressors
Stress: Hecktman (2012), Wittenberg-Lyles et al. (2014), and
Altounji et al. (2012) referred to stress as an harmful effect of
caring, and constant physical and emotional stressors
25. Conclusions
A definition for oncology nurses’ grief was proposed and was followed by a discussion
of how the proposed definition related to the four most used terms in the
metasynthesis. This definition of oncology nurses’ grief was developed by the
researcher as a result of the metasynthesis.
The definition could provide consistency when referring oncology nurses experiences
and would provide clarity for those interested in the issue.
Important differences between the way many of the terms used to describe oncology
nurses’ grief were in the data, compared to the larger body of literature related to
nurses’ grief that was critiqued in the literature review.
For example, compassion fatigue was described in the nurses’ grief literature as an
emotional response to nurses experiencing grief. However, the data for this
metasynthesis presented compassion fatigue as something that included both
emotional and physical responses; which was the same way that burnout was
described in the data.
Similarly, the oncology nurses’ grief data that focused on compassion fatigue described
compassion fatigue was an emotion similar to grief, although there were some data
that described it was a response to experiencing grief. While compassion fatigue is
recommended as the best term for future researchers to use to describe oncology
nurses’ grief based on this metasynthesis, there continues to be some confounding of
the terms associated with oncology nurses’ grief.
26. Implications for Practice
Nurses could be encouraged to form support groups, or staff
committees to brainstorm ways to combat burnout and promote
self-awareness to reduce stress.
Less experienced nurses would benefit most from employers
providing education and training related to all aspects of grief and
stress, as it would give them a good foundation on coping
strategies to deal with grief situations.
Identification of the needs and the implementing of interventions
can offer positive impact on provision of care by oncology nurses
and decrease the occurrence of compassion fatigue and burnout,
particularly for those with less experience.
27. Future Research
Conducting studies that further analyze oncology nurses’ grief,
how grief is unique within the oncology discipline, what causes
grief, and what can be done to prevent or facilitate the impact of
grief.
Further study of the potentially positive outcomes after grief is
experienced by oncology nurses, and how those outcomes can
have a constructive influence on their work.
A more in-depth examination of both burnout and compassion
fatigue, as well as other terms related to oncology nurses’ grief, to
determine if these are separate phenomenon and, if they are
distinct, what is their relationship to each other yet each of them
uniquely meaningful.
28. References
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Pediatric Oncology Nursing, 30(1), 18-23. DOI: 10.1177/1043454212461951
Aycock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2),
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Bush, J. (2009). Compassion fatigue: Are you at risk? Oncology Nursing Forum, 36(1), 24-28. DOI: 10.1188/09.ONF.24-28
Caton, A. P., & Klemm, P. (2006). Introduction of novice oncology nurses to end-of-life care. Clinical Journal of Oncology Nursing, 10(5), 604-
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Edmonds, C., Lockwood, G. M., Bezjak, A., & Nyhof-Young, J. (2012). Alleviating emotional exhaustion in oncology nurses: an evaluation of
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