The effect of videotapes of animals on cardiovascular responses to stress

Animals have long been noted for their ability to moderate cardiovascular responses to stress. To date, however, little attention has been directed towards the ability of videotapes of animals to buffer people from challenges. This study thus explored the effect of five video conditions (fish, bird, primate, control 1 [humans], control 2 [blank screen]) on the heart rate and blood pressure of 100 volunteers before and after exposure to a cognitive stressor. Twenty participants were randomly assigned to each of the video conditions. Both the heart rate and blood pressure (diastolic and systolic) of the participants were recorded after a 10 minute period of relaxation (phase 1), following 10 minutes of exposure to the appropriate video for that condition (phase 2) and again, following a 10 minute period of reading aloud, i.e. a cognitive stressor (phase 3). The videos encouraged relaxation, with participants in all conditions exhibiting significantly (p < 0.001) lower levels of heart rate and blood pressure in phase 2 than phases 1 or 3. Individuals exposed to the videos of birds, fish and primates showing significantly (p < 0.001) lower levels of heart rate and blood pressure in phase 3 than individuals exposed to the control videos. It is concluded that videotapes of certain animals can reduce cardiovascular responses to psychological stress and may help to buffer viewers from anxiety, at least in the short term.

An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area

Setting: Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants: Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). Primary and secondary outcome measures: The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results: Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. Conclusion: There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels.

Cancer Cachexia Care: The Contribution of Qualitative Research to Evidence-Based Practice

Background: Despite its prevalence and prognostic impact, primary cachexia is not well understood. Its potential to cause considerable psychological stress indicates the need for qualitative research to help understand the perspectives of those affected.

Objective: The aims of this study were to describe the perspectives of patients with primary cachexia, of their relatives, and of the healthcare professionals involved in their care and to demonstrate how this evidence can be applied in practice at 4 different levels of application ranging from empathy to coaching.

Methods: A review of the qualitative literature and empirical qualitative investigation was used to understand the experiences of patients and relatives and the perspectives of professionals.

Results: The main worries expressed by patients and relatives concerned appetite loss, changing appearance, prognosis, and social interaction. We also describe their coping responses and their views of professionals’ responses. The main concerns of professionals related to poor communication, lack of clinical guidance, and lack of professional education.

Conclusions: Understanding patients’, families’, and professionals’ perspectives, and mapping that understanding onto what we know about the trajectory and prognosis of the condition, provides the evidence base for good practice. Qualitative research has a central role to play in providing the knowledge base for the nursing care of patients with cachexia.

Implications for Practice: The evidence provided can improve nurses’ insight and assist them in assessment of status, the provision of guidance, and coaching. There is a need for the development of a holistic, information-based integrated care pathway for those with cancer cachexia and their families.

Positive aspects and challenges associated with caring for a dying relative at home

Research has consistently shown that family caregivers have a variety of unmet needs, despite comprehensive professional support for caregivers being a central aim of palliative care. This sub-study of a larger randomized controlled trial sought feedback from 47 primary family caregivers of advanced cancer patients who had recently commenced home palliative care. During semi-structured interviews in their homes, family caregivers were asked to comment on the key challenges associated with their role and whether they could identify challenges. These were associated with their own ill health, family circumstances, insufficient skills to manage patient symptoms, limited time for themselves and inadequate support from health professionals. Despite these challenges, 60% of family caregivers were readily able to identify positive aspects of the role. Previous research has tended to focus on the negative impact of caregiving. The extent to which the positive aspects buffer the negative aspects of the role warrants further exploration, as does the long-term impact of the caregiver role on those who are unable to recognize positive elements.

Dealing with post-traumatic stress disorder: The psychological sequelae of bloody Sunday and the response of state services

Objective: This article describes the political context of health and social care services in Northern Ireland at a the of intense social conflict. Method: Concepts from post-traumatic stress disorder (PTSD) and other relevant international psychological literature are then used to study the experience of the Bloody Sunday families, victims of a traumatic event that happened in Derry in January 1972. Results: High levels of psychological morbidity within this population are reported, alongside some evidence that families had not received services that may have helped resolve the trauma. Conclusions: The authors noted that new services planned as a result of the current peace process may offer social workers and other professionals new ways to address the unmet needs of people traumatized by the Troubles.

Psychological responses after a major fatal earthquake: The effect of preitraumatic dissociation and posttraumatic stress symptoms on anxiety and depression.

Following trauma, most people with initial symptoms of stress recover, but it is important to identify those at risk for continuing difficulties so resources are allocated appropriately. There has been limited investigation of predictors of posttraumatic stress disorder following natural disasters. This study assessed psychological difficulties experienced in 101 adult treatment seekers following exposure to a significant earthquake. Peritraumatic dissociation, posttraumatic stress symptoms, anxiety, depression, and emotional support were assessed. Path analysis was used to determine whether the experience of some psychological difficulties predicted the experience of other difficulties. As hypothesized, peritraumatic dissociation was found to predict posttraumatic stress symptoms and anxiety. Posttraumatic stress symptoms then predicted anxiety and depression. Depression and anxiety were highly correlated. Contrary to expectations, emotional support was not significantly related to other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention.

Psychological processes underlying nurses' handwashing behaviour

Aim/Background Psychological models of behaviour change have been found to be useful in predicting health-related behaviour in patients but have rarely been used in relation to the health behaviour of staff. This study explored the association between a range of psychological variables and self-reported handwashing in a sample of nurses who work in a large general hospital. Method A questionnaire-based cross-sectional, correlational study was used. Questionnaires examining demographics, self-efficacy, perceived importance of handwashing, perception of risk, occupational stress and training related to handwashing were administered to an opportunity sample (n = 76) of nurses drawn from an acute hospital. ANOVAs, correlation and regression analyses were performed to determine significant covariates of handwashing behaviour. Findings There was a weak relationship between demographic variables and self-reported handwashing. The degree to which employees perceived their workplace to assist handwashing and perceived importance of handwashing were related to self-reported handwashing. Accordingly further covariates of these variables were sought. Training received and occupational stress both covaried with nurses’ perceptions of the degree to which their workplace assisted handwashing. Nurses’ beliefs regarding the transmission of infections covaried with perceived importance of handwashing. Conclusion Occupational stress was observed to reduce the perception of having a supportive employer: organisations need to facilitate handwashing and protect staff from factors that have a detrimental impact, such as work-related stress. Nurses’ perceived importance of the potential for poor handwashing practice to contribute to the transmission of infections should be highlighted in interventions.

The role played by a range of psychological variables in nurses’ handwashing behaviour

Background: Psychological models of behaviour change are used to predict patients’ health behaviours but have rarely been used to explore healthcare professionals’ health-related behaviour. Aim: To explore the association between self-reported handwashing and a range of psychological variables in a sample of nurses in a large acute hospital. Results and discussion: Nurses in this study were more likely to wash their hands if they perceived it to be important and if they thought their workplace helped them in doing so. The best predictor of perceived importance was how strongly a nurse believed that poor handwashing practice contributes to spreading infection. Conclusion: In this study, psychological variables such as perception of importance, perception of workplace support, occupational stress and perception of risk were important predictors of handwashing behaviour.

Surveying nursing students on their sources of stress: A validation study

This study tested the psychometric properties of a questionnaire that measured sources of distress and eustress, or good stress, in nursing students. The Transactional model of stress construes stress in these different ways and is frequently used to understand sources of stress, coping and stress responses. Limited research has attempted to measure sources of distress and eustress or sources that can potentially enhance performance and well-being. A volunteer sample of final year nursing students (n = 120) was surveyed in the United Kingdom in 2007. The questionnaire measured sources of stress and measures of psychological well-being were taken to test construct validity. This was tested through an exploratory factor analysis. This reduced the questionnaire from 49 to 29 items and suggested three factors: learning and teaching, placement related and course organization; second, it was analysed by testing the assumptions of the Transactional model, the model on which the questionnaire was based. In line with the assumptions of the model, measures of distress related to adverse well-being, and measures of eustress related to healthier well-being responses. The test–retest reliability estimate was 0.8. While certain programme issues were associated with distress, placement-related experiences were the most important source of eustress.

From stress to distress: Conceptualizing the British family farming patriarchal way of life

‘Rural stress’ and ‘farming stress’ are terms that have become commonly appropriated by British health-based academic disciplines, the medical profession and social support networks, especially since the agricultural ‘crises’ of B.S.E. and Foot and Mouth Disease. Looking beyond the media headlines, it is apparent that the terms in fact are colloquial catch-alls for visible psychological and physiological outcomes shown by individuals. Seldom have the underlying causes and origins of presentable medical outcomes been probed, particularly within the context of the patriarchal and traditionally patrilineal way of life which family forms of farming business activity in Britain encapsulate. Thus, this paper argues that insufficient attention has been paid to the conceptualization of the terms. They have become both over-used and ill-defined in their application to British family farm individuals and their life situations. A conceptual framework is outlined that attempts to shift the stress research agenda into the unilluminated spaces of the family farming ‘way of life’ and focus instead on ‘distress’. Drawing upon theorization from agricultural and feminist geography together with cultural approaches from rural geography, four distinct clusters of distress originate from the thoughts of individuals and the social practices now required to enact patriarchal family farming gender identities. These are explored using case study evidence from ethnographic repeated life history interviews with members of seven farming families in Powys, Mid Wales, an area dominated by family forms of farming business. Future research agendas need to be based firmly on the distressing reality of patriarchal family farming and also be inclusive of those who, having rejected the associated way of life, now lie beyond the farm gate.

The health of children with cerebral palsy and stress in their parents

Aim.  This paper is a report of a study conducted to describe the health of children with cerebral palsy and investigate predictors of stress in their parents. Background.  Children with severe cerebral palsy tend to have poorer health than their able-bodied peers, and their parents are more likely to be stressed and have poorer health. Method.  A cross-sectional survey with home visits using standard questionnaires was administered to parents in 2004–05. A total of 102/199 (51%) children and parents participated. The children were compared with a normative sample. Results.  Children with cerebral palsy had poorer physical health, and 79% of parents reported that their child had moderate to severe pain. Their poorer health, in comparison with the normal sample and measured by the Child Health Questionnaire, was related to feeding problems and seizures, general health perceptions to intellectual and feeding impairment, and family activities with severe motor, intellectual and feeding impairment. Poorer psychological well-being on the hyperactivity domain of the Strengths & Difficulties Questionnaire was related to feeding difficulties, on the prosocial domain to more severe forms of all child impairments, and on the social impairment scale to intellectual impairment. Children with psychological problems had statistically significantly increased odds (OR = 7·2, 95% CIs 2·6–20·3) of having parents with high stress. Conclusion.  Children with cerebral palsy and associated impairments are at higher risk of poorer health and family well-being. A family-centred approach to the care of children with cerebral palsy and their families is essential to ensure both receive adequate care and support.

A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults

Background: The main aims of the study were to assess psychological morbidity among adults nine months after a car bomb explosion in the town of Omagh, Northern Ireland and to identify predictors of chronic posttraumatic stress disorder symptoms.

Method: A questionnaire was sent to all adults in households in The Omagh District Council area. The questionnaire comprised established predictors of PTSD (such as pre-trauma personal characteristics, type of exposure, initial emotional response and long-term adverse physical or financial problems), predictors derived from the Ehlers and Clark (2000) cognitive model, a measure of PTSD symptoms and the General Health Questionnaire.

Results: Among respondents (n = 3131) the highest rates of PTSD symptoms and probable casesness (58.5%) were observed among people who were present in the street when the bomb exploded but elevated rates were also observed in people who subsequently attended the scene (21.8% probable caseness) and among people for whom someone close died (11.9%). People with a near miss (left the scene before the explosion) did not show elevated rates. Exposure to the bombing increased PTSD symptoms to a greater extent than general psychiatric symptoms. Previously established predictors accounted for 42% of the variance in PTSD symptoms among people directly exposed to the bombing. Predictors derived from the cognitive model accounted for 63%.

Conclusions: High rates of chronic PTSD were observed in individuals exposed to the bombing. Psychological variables that are in principle amenable to treatment were the best predictors of PTSD symptoms. Teams planning treatment interventions for victims of future bombings and other traumas may wish to take these results into account.

Stress, coping and satisfaction in nursing students

Aim. This article is a report of a study conducted to explore the relationship between sources of stress and psychological well-being and to consider how different sources of stress and coping resources might function as moderators and mediators on well-being.


Background. In most research exploring sources of stress and coping in nursing students, stress has been construed as psychological distress. Sources of stress likely to enhance well-being and, by implication, learning have not been considered.


Method. A questionnaire was administered to 171 final year nursing students in 2008. Questions were asked to measure sources of stress when rated as likely to contribute to distress (a hassle) and rated as likely to help one achieve (an uplift). Support, control, self-efficacy and coping style were also measured, along with their potential moderating and mediating effects on well-being, operationalized using the General Health Questionnaire and measures of course and career satisfaction.


Findings. Sources of stress likely to lead to distress were more often predictors of well-being than were sources of stress likely to lead to positive, eustress states, with the exception of clinical placement demands. Self-efficacy, dispositional control and support were important predictors, and avoidance coping was the strongest predictor of adverse well-being. Approach coping was not a predictor of well-being. The mere presence of support appeared beneficial as well as the utility of that support to help a student cope.


Conclusion. Initiatives to promote support and self-efficacy are likely to have immediate benefits for student well-being. In course reviews, nurse educators need to consider how students’ experiences might contribute not just to potential distress, but to eustress as well.