Distress Situations Research Articles

Intensive care unit professionals' responses to a new moral conflict assessment tool: A qualitative study.

Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach-moral conflict assessment (MCA)-to characterize moral distress and to facilitate the development of interventions for this problem. To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. In this qualitative study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. The main causes of moral distress related to goals of care, communication, teamwork, respect for patient's preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions.

Psychometric Properties of the Greek Version of Demoralization Scale-II (DS-II) in Patients with Cancer.

The concept of demoralization is used to describe situations of existential distress and self-perceived inability to effectively deal with stressors. The Demoralization Scale-II (DS-II) is a short and modified version of the original DS that measures the level of demoralization in patients. The purpose of this study is to evaluate the psychometric properties of the Greek version of the Greek Demoralisation Scale-II (DS-II GR) in the population of patients with cancer. The main tool used in this cross-sectional study is the DS-II GR translated and evaluated for its psychometric properties in a sample of 150 Greek patients with cancer. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, known groups' validity, cut-off points, internal consistency reliability and test-retest reliability were done. According to the CFA, a two-factor model emerged with a different conceptual content and grouping than the original. The correlation coefficients between DS-II GR and Hospital Anxiety and Depression Scale-Greek (HADS-GR) The internal consistency of DS-II GR for factor 1, factor 2, and total score were measured with Cronbach's alpha and calculated to be 0.906, 0.810, and 0.913. The Greek version of the demoralization scale is reliable and valid for assessing demoralization in Greek patients with cancer.

Moral distress in midwifery practice: A Delphi study

BackgroundMoral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals’ moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice. AimThe aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives. MethodsThis e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes. FindingsTwenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury. Discussion/conclusionThis is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.

Motives for becoming a teacher, coping strategies and teacher efficacy among Swedish student teachers

ABSTRACT The current study examined whether different motives for entering teacher education and different coping strategies in distressful situations during teacher training were associated with teacher efficacy among student teachers. A sample of 517 Swedish student teachers completed a questionnaire. According to the findings from multivariate regression analysis, student teachers who scored higher in intrinsic and altruistic motives and cognitive restructuring, and lower in self-criticism, tended to show greater teacher efficacy.

Moral distress in long-term care questionnaire modification and psychometric evaluation.

Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting. To describe the modification and psychometric evaluation of the Moral Distress Questionnaire. Instrument development and psychometric evaluation. Internal consistency using Cronbach's α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire. A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021. The study was approved by the university's human research protection program. Informed consent was provided to all participants. A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36-0.70) with the given underlying construct. Cronbach's α coefficient was 0.87 for the overall scale and 0.60-0.74 for its subscales which demonstrate good reliabilities. This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses. The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses.

A A Context-Aware Human Distress Alert System for Safety from Interpersonal Violence Using Smartphone Sensors

Interpersonal violence is one of the causes of death globally. Getting help depends on timely response from responders. Development in personal safety technologies have been improved over the years due to the increase in the use of mobile technologies and the miniaturization of electronic sensors. However, existing technologies for communicating distress usually require active user interventions in alerting emergencies. Hence, this study proposes a system for the automatic detection and alert of distress situations arising from violent attacks through smartphone sensors. A fuzzy logic approach was adopted to classify levels of distress situation using input data values from tri-axial accelerometer, gyroscope, sound and proximity sensors. A prototype of the distress detection and alert process was implemented using Java programming language. The system prototype was implemented as an android based real-time application that detects and alerts distress using values from mobile device sensors. Testing the prototype showed that the system can automatically detect and send alert to responders using smartphone.

‘I’m aware of that, but … ’: breaking the silence on moral distress among language teachers

ABSTRACT Moral distress (MD) is defined as knowing what to do in an ethical situation but being unable to do it. Although this definition was originally meant for healthcare practitioners, it is instantly recognised by those in the teaching profession. This study adopted Q methodology to identify and characterise foreign language teachers’ viewpoints regarding morally distressing situations. Thirty-three teachers of English as a foreign language (EFL) performed a card-sorting task. The sources of MD were characterised into three categories: limited control, violation of personal values and lack of voice. Teachers may be reluctant to pathologise MD because it can arise within everyday scenarios. The findings contribute to the development of supportive strategies for EFL teachers in response to various sources of MD.

A Dynamic Spatio-Temporal Stochastic Modeling Approach of Emergency Calls in an Urban Context

Emergency calls are defined by an ever-expanding utilisation of information and sensing technology, leading to extensive volumes of spatio-temporal high-resolution data. The spatial and temporal character of the emergency calls is leveraged by authorities to allocate resources and infrastructure for an effective response, to identify high-risk event areas, and to develop contingency strategies. In this context, the spatio-temporal analysis of emergency calls is crucial to understanding and mitigating distress situations. However, modelling and predicting crime-related emergency calls remain challenging due to their heterogeneous and dynamic nature with complex underlying processes. In this context, we propose a modelling strategy that accounts for the intrinsic complex space–time dynamics of some crime data on cities by handling complex advection, diffusion, relocation, and volatility processes. This study presents a predictive framework capable of assimilating data and providing confidence estimates on the predictions. By analysing the dynamics of the weekly number of emergency calls in Valencia, Spain, for ten years (2010–2020), we aim to understand and forecast the spatio-temporal behaviour of emergency calls in an urban environment. We include putative geographical variables, as well as distances to relevant city landmarks, into the spatio-temporal point process modelling framework to measure the effect deterministic components exert on the intensity of emergency calls in Valencia. Our results show how landmarks attract or repel offenders and act as proxies to identify areas with high or low emergency calls. We are also able to estimate the weekly average growth and decay in space and time of the emergency calls. Our proposal is intended to guide mitigation strategies and policy.

Mental Health and Quality of Professional Life of Healthcare Workers: One Year after the Outbreak of the COVID-19 Pandemic

Background: COVID-19 has radically changed our lives, bringing with it numerous consequences. While this is already true for the general population, it is even more so for a specific job category: healthcare workers. Objective: This study aims to analyze the mental health and quality of professional life of healthcare workers one year after the outbreak of the COVID-19 pandemic. Methods: This study is based on an exploratory and quantitative method. The researchers submitted a questionnaire consisting of scales validated in the literature through the Lime-Survey platform. The dimensions explored included mental health, burnout, compassion fatigue, satisfaction of basic work-related needs, and perceived support from friends and family. The results show how well-being continues to decline due to increased stress, which, in turn, leads to situations of psychological distress and discomfort that are summarized in the appearance of disorders such as, for example, burnout. In this situation of distress, some protective aspects emerge such as, for example, social support, especially in the dimension of friendship. Conclusions: In general, taking care of this category turns out to be essential to be prepared for possible future illnesses and to support people who suffer.

Concept of an Intelligent System for Safety Navigation in Distress Situations using MF-DSC and MF-RTF Radiocommunication Equipment for Non-conventional Vessels Sailing along the Coast of Portugal using ANN Computer System Technology

The article presents the current problem of inability to establish effective communications of the coast of Portugal (lack of A1 and A2 communication areas) and the concept of an intelligent decision support system for the Captain of a non-conventional ship (including a yacht) located in this area using the MF system in an emergency situation. The described problem is important to increase the degree of safety of navigation in the process of effective summoning of RCC assistance, in a situation of danger to life and property of the ship using radio devices of the MF frequency band. The article presents a model of an intelligent decision support system for the captain by implementing artificial neural networks ANN, taking advantage of the phenomena of weaker ionization in the upper layers of the ionosphere, at night, which translates into an increase in the operating range of radio communications on MF radio waves. The results of simulations of the increased range of A2 communication area at night time, enabling the establishment of MF radio communication with RCC marine rescue centers in an emergency situation by the captain of a non-conventional vessel in the area in question, are presented.

The Radiocommunication Support Decision System to Use in Distress Situations for Captains of Small Non-conventional Vessels Operating in the Caribbean Sea Area

The paper presents the concept of a Radio Communication System to support the decision of the captain of a small non-conventional vessel including a yacht sailing in the waters of the Caribbean Sea in a dangerous situation requiring a call for RCC assistance. This is important to enhance boating safety in the area, where, due to the reduced and non-overlapping accessible areas of the A1 and A2 communications zones, calling for RCC assistance using common VHF/MF radio equipment is limited. In the event of danger to life and property on a yacht, the ability to contact Marine Rescue Centers is a primary concern. This paper presents a model of an intelligent system for supporting the captain in making the right navigation decision, in a dangerous situation, based on the method of artificial neural networks ANN. The article presents an example of numerical simulation of operation of the discussed system of Radio Communication decision support, assuming a specific position of the small non-conventional vessel in distress, with reference to the existing communication areas A1, A2 in the Caribbean Sea. The result of the simulation is related to the calculation of the distance to the nearest zone, enabling the establishment of communication with the marine Rescue Center to distress call, the value of the new corrected course of the small non-conventional vessel and the time of arrival at the above-mentioned zone.

Adult Avoidant Attachment, Attention Bias, and Emotional Regulation Patterns: An Eye-Tracking Study.

Proximity-seeking in distress situations is one of attachment theory's primary strategies; insecure individuals often also develop secondary strategies. The mechanisms implied in attachment deactivation constitute a key issue in the current debate related to their role in support-seeking. The main aim of this study is to investigate the attachment deactivation strategy and the processes of proximity/support-seeking under distress conditions by analyzing the attentional processes (i.e., an essential emotion-regulation strategy), using eye-tracking techniques. Seventy-two participants (45 female; Mage 23.9 ± 3.97) responded to the ECR-R questionnaire in order to identify their attachment style. They participated in an experimental situation in which they had to choose between pictures of care or pictures of food, following the presentation of threatening or neutral prime conditions (via the pictures' stimuli). Results showed that a care-consistency response pattern was the most frequent pattern of response, particularly under a threatening condition; on the contrary, only avoidant individuals showed a lower care-consistency response pattern by choosing food pictures. The overall findings demonstrate that avoidant individuals used the deactivation strategy to process comfort-related attachment pictures, suggesting that they considered these stimuli to be threatening. The implications for attachment theory and particularly for avoidant strategies are discussed.

Show Me Your Face: Towards an Automated Method to Provide Timely Guidance in Visual Analytics.

Providing guidance during a Visual Analytics session can support analysts in pursuing their goals more efficiently. However, the effectiveness of guidance depends on many factors: Determining the right timing to provide it is one of them. Although in complex analysis scenarios choosing the right timing could make the difference between a dependable and a superfluous guidance, an analysis of the literature suggests that this problem did not receive enough attention. In this paper, we describe a methodology to determine moments in which guidance is needed. Our assumption is that the need of guidance would influence the user state-of-mind, as in distress situations during the analytical process, and we hypothesize that such moments could be identified by analyzing the user's facial expressions. We propose a framework composed by a facial recognition software and a machine learning model trained to detect when to provide guidance according to changes of the user facial expressions. We trained the model by interviewing eight analysts during their work and ranked multiple facial features based on their relative importance in determining the need of guidance. Finally, we show that by applying only minor modifications to its architecture, our prototype was able to detect a need of guidance on the fly and made our methodology well suited also for real-time analysis sessions. The results of our evaluations show that our methodology is indeed effective in determining when a need of guidance is present, which constitutes a prerequisite to providing timely and effective guidance in VA.

An Insight into the Covid-19 Pandemic's Effect on Mental Health

A novel coronavirus is known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 was identified at the end of 2019 in Wuhan City, Hubei in China. Due to the emergence in the cases of the COVID-19, there was complete lockdown in the world which led to a situation of psychological distress among the population and socio-economic crisis. Objectives: The main goalofthestudyistolearning the Insight into the impact of COVID-19 pandemic on mental health in the general people all over the world. Methods: This was an experimental study. The subject’s demographic details and responses were collected with the help of a standardized questionnaire. The collected data were entered in Microsoft Excel and then suitablegraphical and inferential statistical investigation was performed. Results: It was found that the Fear of Covid-19 (FCV-19) scores on average, were increased among females (17.2), younger adults (16.15) and older adults (17.78). The frequency of stress, depression and anxietywas higher in younger adults (18-27 years) when compared to older adults according to this study. Female subjects had a higher prevalence of depression, anxiety and stress when compared to the males. Conclusion: From this study, it is evident that there is a need for early strategies, programs and mental health policies to alleviate the effect of the pandemic on mental health. People should be educated regarding the COVID-19 disease, its preventive measures and also the importance of mental health during the times of this deadly pandemic.

The student's drawing of teacher's pictorial Value as a predictor of the student-teacher relationship and school adjustment.

This study employs the scale of Value from Pictorial Assessment of Interpersonal Relationships (PAIR) to investigate the links between the importance attributed by primary students to their teachers and two independent measures of scholastic wellbeing, provided by teachers and parents. During middle childhood, the teacher is one of the most significant adults with whom children interact daily; a student-teacher relationship warm and free from excessive dependency and conflict is very important for children wellbeing; however, children's recognition of teacher importance as an authority figure has been seldom studied. Children aged 7-11 years were individually asked to draw themselves and one of their teachers in two situations (relational Wellbeing and relational Distress); the scale of Value from PAIR was used as a proxy of the importance attributed to teachers in each situation. Teachers completed the Student-Teacher Relationship Scale for Closeness, Conflict, and Dependency of each child; parents answered two items about their children's School Adjustment. All the study variables were firstly analyzed to check gender and age differences. Boys valorized more than girls the teacher's figure; however, teachers perceived more Closeness and less Conflict with girls. Dependency and Conflict decreased with age, as well as (albeit slightly) School Adjustment. To assess the links between pictorial valorization of the teacher in Wellbeing and Distress and teachers' and parents' evaluations, four separate hierarchical regressions were performed, namely, Closeness, Dependency, Conflict, and School Adjustment, controlling children's sex and age. The teacher's pictorial Value in Wellbeing appeared to be related to Closeness and School Adjustment, while a negative relationship emerged between Value and Dependency in Distress. In sum, the recognition of the teacher's role as an authority figure does not hinder a warm student-teacher relationship and impacts positively on school adjustment. In situations of Distress, dependent pupils showed a diminished appreciation of the teacher's importance, possibly as a result of a defensive stance.

Creativity and art therapies to promote healthy aging: A scoping review.

The purpose of this scoping review is to investigate the value of creative arts therapies in healthy older adults. This article aims to shed light on current knowledge concerning the effectiveness of art therapies (ATs) for the prevention of common age-related conditions using the definition of art therapy provided by the American Art Therapy Association (AATA), as well as Cohen’s conceptual framework for the psychological conceptualization of the relationship between the arts and health in later life. The objective is to carefully capture subthreshold situations of distress, which are often not taken into account and primarily involve psychological aspects that are crucial in the multidimensional perspective of healthy aging. Twelve articles were selected and examined following an initial electronic search on 3 databases. A thematic analysis of the results identified four major themes: improving cognitive performance and proprioception; enhancing self-identity and meaningful life; reducing feelings of loneliness and depressive symptoms; and the importance of socialization. All these aspects constitute the basis for preventing psychological distress and enhancing mental well-being for healthy aging.

Distressed but Highly Satisfied: Professional and Personal Distress of Nepali Doctors

Background: This research studied the prevalence of professional and personal distress of Nepali doctors, and examined the impact of their professional quality of life (ProQOL) on their distress. Aim: To examine the situation of personal and professional distress and explore interrelationships between measures of ProQOL (burnout - BO, secondary traumatic stress - STS, and compassion satisfaction - CS) with personal distress (anxiety, depression and somatic burden) of Nepali doctors. Methods: A survey design was used to examine the personal and professional distress of doctors using an online and a paper-and-pencil survey with the use of Somatic Symptoms Scale (SSS-8), Hopkins Symptoms Checklist (HSCL-25) and Professional Quality of life Scale in Nepali (ProQOL5-N) tools. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques were used to measure the influence of professional distress on personal distress. Results: The prevalence of anxiety, depression, psychosomatic distress and suicide risks of Nepali doctors (N= 557) were 30.89 %, 25.41 %, 20.50% and 5.70% respectively. BO and STS scores showed moderate risks (BO = 95.25% and STS = 76.23 %), with just over 1% doctors at high risk for BO and STS (1.28% and 1.65% respectively). Nepali doctors were highly satisfied with their service (CS = 93.42%). The data on SEM showed a reasonably good fit between the STS and CS measures and levels of personal distress of the studied population, but BO could not be tested. A moderate but statistically significant positive effect of STS on personal distress, except psychosomatic distress, was found. The effect of CS on personal distress could not be determined. Conclusions: One-fifth of Nepali doctors had a high level of personal distress. The risk for BO and STS was moderate. It was found that Nepali doctors found highly satisfied with their service. The impact of professional distress on personal distress could not be fully determined

The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward

Numerous studies point to the acute distress associated with the experience of coping with severe mental illness and psychiatric hospitalization. Another strand of research notes the therapeutic benefits of psychodrama and its efficacy in increasing empathy and self-awareness, improving interpersonal relationships, reducing stress and anxiety, and in treating particularly vulnerable populations for whom traditional psychotherapy’s usefulness is limited. The goal of this paper is to provide a framework for understanding the potential of group sharing in dealing with the experience of loneliness and distress, and to serve as a space for relatedness and self-expression in psychodrama group therapy. A qualitative action research study following an open inpatients’ psychodrama group in a psychiatric hospital in Israel demonstrates the role of group sharing in creating an accommodating space of self-expression, relatedness, and mutual support, which offers relief for the distress of psychiatric inpatients. Within the inpatients’ group, the participants used sharing to distribute the burden among the group members along with the resources to cope with it. The paper seeks to illuminate the unique contribution of a therapeutic tool rarely dealt with by the existing literature–the group sharing—in dealing with situations of acute mental distress.

Moral distress experienced by neonatal intensive and paediatric care nurses in Northern Ghana: a qualitative study.

Moral distress has been studied widely in nursing but not in developing economies. To investigate how moral distress is experienced by nurses working in neonatal intensive care and paediatric wards in Northern Ghana and to determine support measures offered by nurse managers. Qualitative descriptive method. Forty nurses and fourteen nurse managers working with children in four hospitals in Northern Ghana were interviewed. Thematic data analysis was carried out. Six themes were identified: nurses experience morally distressing situations due to a variety of causes; the impact of morally distressing situations on nurses; coping mechanisms of nurses who experienced morally distressing situations; recommendations made by the nurses to reduce the incidence of moral distress; inadequate support measures available to nurse managers and nurse managers experience moral distress too. The causes of moral distress in developed and developing economies are similar. The frequency and intensity of moral distress is high in Northern Ghana. Consistent with other studies conducted in Africa, nurses and nurse managers relied on their religious faith as a form of resilience. No support measures are available to nurse managers to support nurses who experience moral distress.

Supporting school nurses to deliver emotional and mental health interventions: a service evaluation

School nurses often encounter children and young people with emotional and mental health needs and therefore need to be able to manage potentially distressing situations. A service evaluation explored the experiences and perceptions of a small school nursing team of the support they receive to deliver emotional and mental health interventions. Three school nurses and one child and adolescent mental health services (CAMHS) practitioner, all working in a remote and rural area of Scotland, took part in individual semi-structured interviews.Peer support emerged as the most important facilitator but participants lacked time to access it. Training was identified as another crucial source of support, but again time for it was lacking. Moreover, limited access to further support services for children and young people, and a lack of recognition and understanding of participants’ role by others, made it more challenging for participants to deliver emotional and mental health interventions. School nurses could be better supported in that aspect of their role by ensuring they have time for reflection and learning; by enhancing the training, tools and resources available to them; and by improving their professional recognition within and outside the NHS.