Why renal nurses cope so well with their workplace stressors

Background: Previous studies have found significant stressors experienced by nurses working in haemodialysis units yet renal nurses appear to report less burnout than other nurses. Objectives: This study aims to undertake an inductive process to better understand the stressors and the coping strategies used by renal nurses that may lead to resilience. Method: Sixteen haemodialysis nurses from a metropolitan Australian hospital and two satellite units participated in open-ended interviews. Data were analysed from a grounded theory methodology. Measures of burnout and resilience were also obtained. Results: Two major categories of stressors emerged. First, due to prolonged patient contact, family-like relationships developed that lead to the blurring of boundaries. Second, participants experienced discrimination from both patients and staff. Despite these stressors, the majority of participants reported low burnout and moderately high-to-high levels of resilience. The major coping strategy that appeared to promote resilience was emotional distancing, while emotional detachment appeared to promote burn-out. Conclusion: Assisting nurses to use emotional distancing, rather than emotional detachment strategies to engender a sense of personal achievement may promote resilience.

Metacognitive therapy for alcohol abuse and dependence

While the consumption of alcohol has been part of the collective psyche of Australians since colonisation, the overconsumption of alcohol has been and continues to be a significant problem for the Australian community. Currently motivational interviewing and cognitive behaviour therapy are seen as the two standard psychological interventions for alcohol abuse and dependence. While these two approaches have shown significant impact on reducing alcohol abuse and dependence, they are not without their limitations. As such there is a need to continue to explore the application of newer developments in psychotherapy to the treatment problematic drinking behaviours. In this chapter we propose that Metacognitive Therapy is one such psychotherapy that is likely to provide a promising new approach to the treatment of alcohol abuse and dependence. In this chapter we will first briefly outline the history and significance of problematic drinking behaviours in Australia. Following this, we will quickly summarise the literature regarding motivational interviewing and cognitive behaviour therapy. Next we will provide an outline of the theoretical framework of Metacognitive Therapy and then describe two brief case studies illustrating the application of Metacognitive Therapy to the treatment of alcohol abuse and dependence. From this discussion we propose that the combination of Motivational Interviewing and Metacognitive Therapy is a promising new approach that can provide great assistance for the treatment of alcohol abuse or dependence.

Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence : a systematic review

We reviewed the effect of behavioural telehealth interventions on glycaemic control and diabetes self-management in patients with type 2 diabetes. The databases CINAHL, Medline and psychINFO were searched in August 2012. Journal articles were selected that had been published in English with a randomized controlled trial design using a usual care comparison group, and in which the primary intervention component was delivered by telehealth. Relevant outcome measures were glycaemic control and one or more of the following diabetes self-care areas: diet, physical activity, blood glucose self-monitoring (BGSM) or medication adherence. Interventions were excluded if they were primarily based on telemonitoring. The search retrieved 1027 articles, from which 49 were selected based on their title and abstract. Fourteen articles (reporting 13 studies) met the eligibility criteria for inclusion. Four studies reported significant improvements in glycaemic control. Five of eight studies on dietary adherence reported significant treatment effects, as did five of eight on physical activity, four of nine on blood glucose self-monitoring, and three of eight on medication adherence. Overall, behavioural telehealth interventions show promise in improving the diabetes self-care and glycaemic control of people with type 2 diabetes.

General belongingness, workplace belongingness, and depressive symptoms

Research has shown that a strong relationship exists between belongingness and depressive symptoms; however, the contribution of specific types of belongingness remains unknown. Participants (N=369) completed the sense of belonging instrument, psychological sense of organizational membership, and the depression scale of the depression anxiety stress scales. Factor analysis demonstrated that workplace and general belongingness are distinct constructs. When regressed onto depressive symptoms, these belongingness types made independent contributions, together accounting for 45% of variance, with no moderation effects evident. Hence, general belongingness and specific workplace belongingness appear to have strong additive links to depressive symptoms. These results add support to the belongingness hypothesis and sociometer theory and have significant implication for depression prevention and treatment

Symposium - How effective are brief motivational interviewing interventions : Are they necessary? Do they require enhancement? Can they be translated into routine clinical practice?

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. Design and methods: This study aimed to determine how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change among adults with comorbid depression and alcohol misuse (n=202) participating in a clinical trial. The primary focus was on changes in Beck Depression Inventory fastscreen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. Results: There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Discussion and Conclusion: Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity...

Quality of life in chronic fatigue syndrome

Whilst the debilitating fatigue experienced in patients suffering from Chronic Fatigue Syndrome (CFS) results in a subjective marked impairment in functioning, little research has investigated the impact of this disorder on quality of life. Forty-seven subjects with a confirmed diagnosis of CFS and 30 healthy controls were compared using the Sickness Impact Profile (SIP). A subgroup of subjects were interviewed regarding the impact CFS has had on their social and family relationships, work and recreational activities. Results from both the SIP and the interview revealed that CFS subjects had significantly impaired quality of life, especially in areas of social functioning. These findings highlight the importance of addressing the social isolation and loss of role functioning experienced by CFS sufferers.

Effects of family environment on negative symptoms and quality of life of psychotic patients

This study tested the hypothesis that negative symptoms and quality of life for patients with functional psychoses are associated with family environment. Fifty-seven first-admission patients with functional psychoses were assessed at hospital admission for severity of psychopathology and premorbid adjustment. Relatives residing with patients rated the family environment at admission and one month after discharge on the Family Environment Scale. Patients made the same ratings after discharge. Six months later, patients were reassessed on severity of psychopathology, negative symptoms, and quality of life. Multiple regression analyses showed that higher levels of positive emotional expressiveness in the family predicted milder and fewer negative symptoms and better quality of life at follow-up. The prediction was statistically independent of the initial severity of psychopathology or premorbid adjustment

Coping resources, coping strategies and adaptation to organisational change : direct or buffering effects?

This study examined the effects of personal and social resources, coping strategies and appraised stress on employees' levels of anxiety and depression. In relation to the effects of resources and coping strategies, two different models were tested. The main effects model proposes that, irrespective of the level of stress, coping resources and coping strategies have direct effects on well-being. In contrast, the buffering model predicts that the buffering effects of coping resources and strategies are only evident at high levels of stress. One hundred lawyers completed a structured self-administered questionnaire that measured their personal and social resources, use of problem-focused and emotion-focused coping strategies, and appraisals of the stressfulness of the situation. Results revealed generally strong support for the main effects model in the prediction of employee levels of anxiety and depression. Lower levels of anxiety were linked to judgements of lower levels of organizational change, greater self-confidence, greater internality of control beliefs and less use of emotion-focused coping strategies. Lower levels of depression in employees were also linked to judgements of lower levels of organizational change, greater use of resources and less appraised stress. There was only limited support for the buffering effects model. Due to the small size of the sample, the findings need to be explored further in other contexts.

The relationship between self-esteem and psychological adjustment in young adolescents

The study adopts a multi-dimensional construct of self-esteem to examine the relationship between self-perception and psychological adjustment in order to identify specific dimensions that discriminate between disturbed and non-disturbed groups. The disturbed group (n = 33) is derived from a clinical sample and are matched with a non-disturbed group (n = 33) of adolescents. Results indicate that dimensional self-concept scores are significantly lower for clinical subjects while there are no significant differences between groups on the mathematics, honesty, and physical ability dimensions. These findings provide a more fine grained understanding of the relationship between self-esteem and psychological adjustment and emphasize the need to examine self-esteem in terms of its particular dimensions.

The psychological treatment of refugees and asylum seekers : what does the literature tell us?

Over the past five years, Australia has accepted approximately 50 000 individuals through its Humanitarian program. To integrate these individuals specialised medical and psychological services have been established in major centres of Australia. Australia has been involved in a heated and partisan debate as to the policy of the government in responding to the refugee situation. Regardless of the outcome of the debate, it is imperative that Australia establishes and develops effective policies and processes to respond to the mental health needs of refugees and asylum seekers. To this end, the current review provides an overview of published studies relating to the psychological treatment of refugees and asylum seekers, as well as studies covering the delivery of related services in response to the needs of this group. In this review we aim to provide an informed perspective in terms of research evidence where this is available. Reported research is supported by findings from local focus groups conducted in Queensland, Australia. The overall aim is to provide an optimum response to facilitate the development of effective and humane programs for a significantly disadvantaged group in our community.

Social adjustment and symptomatology in two types of homeless adolescents : runaways and throwaways

Previous research on homeless adolescents has largely ignored the distinction between those who have left home on their volition (runaways) and those who have been forced to leave (throwaways). Fifty-two homeless adolescents in Brisbane, Australia, were assessed to compare male and female runaways and throwaways for social adjustment and symptomatology. Differences for social adjustment (antisocial tendencies and aggression) and symptomatology (social isolation and depression) were predicted. Results indicated that male runaways were significantly more hostile than male throwaways (p < 0,001), and significantly more socially isolated than female runaways (p < 0,025). Female throwaways, however, were significantly more hostile than male throwaways (p < 0,025) and female runaways (p < 0,025). Yet homeless males overall had a significantly stronger urge to act out hostility than homeless females (p < 0,025). In addition, female throwaways were significantly more antisocial than male throwaways (p < 0,001). There were no significant differences for depression. A theory of inner social control (Hirschi, 1969), postulating absence of bonding in earlier socialization, was supported.

Parent and adolescent perceptions of family functioning : a comparison of clinic and non-clinic families

In this paper two studies are reported which compare (a) the perceptions of family functioning held by clinic and non-clinic adolescents, and (b) the perceptions of family functioning held by adolescents and their mothers in clinic and non-clinic families. In Study 1, matched group of clinic and non-clinic adolescents were compared on their responses to a 30-item scale (ICPS) designed to measure three factors of family functioning: Intimacy (high vs. low), Parenting Style (democratic vs. controlled) and Conflict (high vs. low). Clinic and non-clinic adolescents were also compared on their responses to a multi-dimensional measure of adolescent self-concept. Although there was little difference between the two groups of adolescents in terms of their perceptions of family functioning, there were strong relationships between the self-concept variables and the family functioning variables. In Study 2, comparisons were made between the perceptions of family functioning held by mothers and adolescents for both clinical and non-clinic families. There were no differences between the two groups of adolescents in terms of their perceptions of family functioning, although there were clear differences between the two groups of mothers. In addition, clinic adolescents and their mothers did not differ in their perceptions of the family, whereas adolescents in the non-clinic group saw their families significantly as less intimate and more conflicted than did their mothers.

Alcoholism and family interaction

In i6 families, half of which had an alcoholic parent, both parents and an adolescent were videotaped interacting with each other. Mothers, fathers and the adolescent in each family viewed the videotaped interaction and completed ratings of themselves and the other two family members on levels of anxiety, involvement, dominance and friendliness. In families with an alcoholic parent, adolescents and their mothers rated family members as less anxious than did adolescents and mothers in families without a drinking problem. Also mothers in the alcoholic families rated family members as being more involved, and their ratings were higher than mothers in other families. Alcoholic families rated parent-adolescent interactions as more dominant and friendlier. At least in these videotaped interactions where alcohol was not being consumed, mothers in alcoholic families adopted a more positive view of family members than mothers in other families. In addition, possibly due to the efforts of fathers not to drink and memories of interactions when he was drunk, alcoholic families perceived their family interactions as more dominant and friendlier than families without an alcohol-related problem. [Schweitzer R, Wilks j, Callan vJ. Alcoholism and family interaction.

Comparing child product safety concerns with injury incidents : does the evidence support the response?

Background Efficient effective child product safety (PS) responses require data on hazards, injury severity and injury probability. PS responses in Australia largely rely on reports from manufacturers/retailers, other jurisdictions/regulators, or consumers. The extent to which reactive responses reflect actual child injury priorities is unknown. Aims/Objectives/Purpose This research compared PS issues for children identified using data compiled from PS regulatory data and data compiled from health data sources in Queensland, Australia. Methods PS regulatory documents describing issues affecting children in Queensland in 2008–2009 were compiled and analysed to identify frequent products and hazards. Three health data sources (ED, injury surveillance and hospital data) were analysed to identify frequent products and hazards. Results/Outcomes Projectile toys/squeeze toys were the priority products for PS regulators with these toys having the potential to release small parts presenting choking hazards. However, across all health datasets, falls were the most common mechanism of injury, and several of the products identified were not subject to a PS system response. While some incidents may not require a response, a manual review of injury description text identified child poisonings and burns as common mechanisms of injuries in the health data where there was substantial documentation of product-involvement, yet only 10% of PS system responses focused on these two mechanisms combined. Significance/contribution to the field Regulatory data focused on products that fail compliance checks with ‘potential’ to cause harm, and health data identified actual harm, resulting in different prioritisation of products/mechanisms. Work is needed to better integrate health data into PS responses in Australia.

Submission to National Inquiry into Children in Immigration Detention from The Australian Psychological Society

Executive Summary The Australian Psychological Society categorically condemns the practice of detaining child asylum seekers and their families, on the grounds that it is not commensurate with psychological best practice concerning children’s development and mental health and wellbeing. Detention of children in this fashion is also arguably a violation of the UN Convention on the Rights of the Child. A thorough review of relevant psychological theory and available research findings from international research has led the Australian Psychological Society to conclude that: • Detention is a negative socialisation experience. • Detention is accentuates developmental risks. • Detention threatens the bonds between children and significant caregivers. • Detention limits educational opportunities. • Detention has traumatic impacts on children of asylum seekers. • Detention reduces children’s potential to recover from trauma. • Detention exacerbates the impacts of other traumas. • Detention of children from these families in many respects is worse for them than being imprisoned. In the absence of any indication from the Australian Government that it intends in the near future to alter the practice of holding children in immigration detention, the Australian Psychological Society’s intermediate position is that the facilitation of short-term and long-term psychological development and wellbeing of children is the basic tenet upon which detention centres should be audited and judged. Based on that position, the Society has identified a series of questions and concerns that arise directly from the various psychological perspectives that have been brought to bear on estimating the effects of detention on child asylum seekers. The Society argues that, because these questions and concerns relate specifically to improvement and maintenance of child detainees’ educational, social and psychological wellbeing, they are legitimate matters for the Inquiry to consider and investigate. • What steps are currently being taken to monitor the psyc hological welfare of the children in detention? In particular, what steps are being taken to monitor the psychological wellbeing of children arriving from war-torn countries? • What qualifications and training do staff who care for children and their families in detention centres have? What knowledge do they have of psychological issues faced by people who have been subjected to traumatic experiences and are suffering high degrees of anxiety, stress and uncertainty? • What provisions have been made for psycho-educational assessment of children’s specific learning needs prior to their attending formal educational programmes? • who are suffering chronic and/or vicarious trauma as a result of witnessing threatening behaviour whilst in detention? • What provisions have been made for families who have been seriously affected by displacement to participate in family therapy? • What critical incident debriefing procedures are in place for children who have witnessed their parents, other family members, or social acquaintances engaging in acts of self-harm or being harmed while in detention? What psychotherapeutic support is in place for children who themselves have been harmed or have engaged in self- harmful acts while in detention? • What provisions are in place for parenting programmes that provide support for parents of children under extremely difficult psychological and physical circumstances? • What efforts are being made to provide parents with the opportunity to model traditional family roles for children, such as working to earn an income, meal preparation, other household duties, etc.? • What opportunities are in place for the assessment of safety issues such as bullying, and sexual or physical abuse of children or their mothers in detention centres? • How are resources distributed to children and families in detention centres? • What socialization opportunities are available either within detention centres or in the wider community for children to develop skills and independence, engage in social activities, participate in cultural traditions, and communicate and interaction with same-age peers and adults from similar ethnic and religious backgrounds? • What access do children and families have to videos, music and entertainment from their cultures of origin? • What provisions are in place to ensure the maintenance of privacy in a manner commensurate with usual cultural practice? • What is the Government’s rationale for continuing to implement a policy of mandatory detention of child asylum seekers that on the face of it is likely to have a pernicious impact on these children’s mental health? • In view of the evidence on the potential long-term impact of mandatory detention on children, what processes may be followed by Government to avoid such a practice and, more importantly, to develop policies and practices that will have a positive impact on these children’s psychological development and mental health?