Does vicarious traumatisation affect oncology nurses?:A literature review

It is widely documented that nurses experience work-related stress [Quine, L., 1998. Effects of stress in an NHS trust: a study. Nursing Standard 13 (3), 36-41; Charnley, E., 1999. Occupational stress in the newly qualified staff nurse. Nursing Standard 13 (29), 32-37; McGrath, A., Reid, N., Boore, J., 2003. Occupational stress in nursing. International Journal of Nursing Studies 40, 555-565; McVicar, A., 2003. Workplace stress in nursing: a literature review. Journal of Advanced Nursing 44 (6), 633-642; Bruneau, B., Ellison, G., 2004. Palliative care stress in a UK community hospital: evaluation of a stress-reduction programme. International Journal of Palliative Nursing 10 (6), 296-304; Jenkins, R., Elliott, P., 2004. Stressors, burnout and social support: nurses in acute mental health settings. Journal of Advanced Nursing 48 (6), 622-631], with cancer nursing being identified as a particularly stressful occupation [Hinds, P.S., Sanders, C.B., Srivastava, D.K., Hickey, S., Jayawardene, D., Milligan, M., Olsen, M.S., Puckett, P., Quargnenti, A., Randall, E.A., Tyc, V., 1998. Testing the stress-response sequence model in paediatric oncology nursing. Journal of Advanced Nursing 28 (5), 1146-1157; Barnard, D., Street, A., Love, A.W., 2006. Relationships between stressors, work supports and burnout among cancer nurses. Cancer Nursing 29 (4), 338-345]. Terminologies used to capture this stress are burnout [Pines, A.M., and Aronson, E., 1988. Career Burnout: Causes and Cures. Free Press, New York], compassion stress [Figley, C.R., 1995. Compassion Fatigue. Brunner/Mazel, New York], emotional contagion [Miller, K.I., Stiff, J.B., Ellis, B.H., 1988. Communication and empathy as precursors to burnout among human service workers. Communication Monographs 55 (9), 336-341] or simply the cost of caring (Figley, 1995). However, in the mental health field such as psychology and counselling, there is terminology used to captivate this impact, vicarious traumatisation. Vicarious traumatisation is a process through which the therapist's inner experience is negatively transformed through empathic engagement with client's traumatic material [Pearlman, L.A., Saakvitne, K.W., 1995a. Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In: Figley, C.R. (Ed.), Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel, New York, pp. 150-177]. Trauma not only affects individuals who are primarily present, but also those with whom they discuss their experience. If an individual has been traumatised as a result of a cancer diagnosis and shares this impact with oncology nurses, there could be a risk of vicarious traumatisation in this population. However, although Thompson [2003. Vicarious traumatisation: do we adequately support traumatised staff? The Journal of Cognitive Rehabilitation 24-25] suggests that vicarious traumatisation is a broad term used for workers from any profession, it has not yet been empirically determined if oncology nurses experience vicarious traumatisation. This purpose of this paper is to introduce the concept of vicarious traumatisation and argue that it should be explored in oncology nursing. The review will highlight that empirical research in vicarious traumatisation is largely limited to the mental health professions, with a strong recommendation for the need to empirically determine whether this concept exists in oncology nursing.

Networked learning ten years on: the rise of the virtual graduate school

The aim of this paper is to reflect on how conceptions of networked learning have changed, particularly in relation to educational practices and uses of technology, that can nurture new ideas of networked learning to sustain multiple and diverse communities of practice in institutional settings. Our work is framed using two theoretical frameworks: Giddens's (1984) structuration theory and Callon & Latour's (1981) Actor Network Theory as critiqued by Fox (2005) in relation to networked learning. We use these frameworks to analyse and critique ideas of networked learning embodied in both cases. We investigate three questions: (a) the role of individual agency in the development of networked learning; (b) the impact of technological developments on approaches to supporting students within institutional infrastructures; and (c) designing networked learning to incorporate Web 2.0 practices that sustain multiple communities and foster engagement with knowledge in new ways. We use an interpretivist approach by drawing on experiential knowledge of the Masters programme in Networked Collaborative Learning and the decision making process of designing the virtual graduate schools. At this early stage, we have limited empirical data related to the student experience of networked learning in current and earlier projects. Our findings indicate that the use of two different theoretical frameworks provided an essential tool in illuminating, situating and informing the process of designing networked learning that involves supporting multiple and diverse communities of practice in institutional settings. These theoretical frameworks have also helped us to analyze our existing projects as case studies and to problematize and begin to understand the challenges we face in facilitating the participation of research students in networked learning communities of practice and the barriers to that participation. We have also found that this process of theorizing has given us a way of reconceptualizing communities of practice within research settings that have the potential to lead to new ideas of networked learning.

Information professionals in business context: new professionals, old skills

This communication aims to present some reflections regarding the importance of information in organizational context, especially in business context. The ability to produce and to share expertise and knowledge among its employees is now a key factor in the success of any organization. However, it’s also true that workers are increasingly feeling that too much information can hurt their performance. The existence of skilled professionals able to organize, evaluate, select and disseminate information in organizations appears to be a prerequisite for success. The skills necessary for the formation of a professional devoted to the management of information and knowledge in the context of business organizations will be analysed. Then data collected in two focus group discussion with students from a graduate course in Business Information, from Polytechnic Institute of Porto, Portugal, a will be examined.

Reforms of the pre-graduate curriculum for medical students: the Bologna process and beyond.

For several years, all five medical faculties of Switzerland have embarked on a reform of their training curricula for two reasons: first, according to a new federal act issued in 2006 by the administration of the confederation, faculties needed to meet international standards in terms of content and pedagogic approaches; second, all Swiss universities and thus all medical faculties had to adapt the structure of their curriculum to the frame and principles which govern the Bologna process. This process is the result of the Bologna Declaration of June 1999 which proposes and requires a series of reforms to make European Higher Education more compatible and comparable, more competitive and more attractive for Europeans students. The present paper reviews some of the results achieved in the field, focusing on several issues such as the shortage of physicians and primary care practitioners, the importance of public health, community medicine and medical humanities, and the implementation of new training approaches including e-learning and simulation. In the future, faculties should work on several specific challenges such as: students' mobility, the improvement of students' autonomy and critical thinking as well as their generic and specific skills and finally a reflection on how to improve the attractiveness of the academic career, for physicians of both sexes.

Registered nurses' perceptions of factors impacting on their continuing education /

This qualitative study examined the effects of hospital restructuring on a group of nurses at a community hospital. Eleven nurses were asked questions in order to gain insight into their experience in this situation. Ten of these participants were female, and one was male. The intent was to gather information about how restructuring has affected their lives, including, their motivational factors and barriers to participation in continuing education, and their descriptions of their workplace environment. Audiotaped interviews were conducted on two occasions to obtain this data. Emergent themes included the nurses' comments about continuing education, motivational factors, barriers that included geography and time, reactions of co-workers, restructuring, the College of Nurses' Quality Assurance Program including peer feedback, and performance appraisals. The literature review compares the barriers and motivational factors to the previous research findings. Thus, this study gave voice to the experience of this group of nurses, working in a healthcare setting that is involved in restructuring. This information is important to the healthcare system, since many areas are involved in restructuring. The whole process, if it is to be successful, depends on the frontline workers, namely the nurses. Thus, if there is anything to be learned from this group of people, that could be used to improve this progression, everyone would benefit from this information, were it to be implemented. Everyone is a stakeholder in the quality of healthcare in our province. The frontline workers are the ones that hold the vantage point to be able to provide suggestions for the changes needed to successful. These nurses are not just motivated by work issues however, and educating them and motivating them will also improve the care provided through increased knowledge and enhanced self-esteem.

Exploring the events that engage graduate students in transformative learning /

This research explored the events that engaged graduate students in transformative learning within a graduate program in education. This context was chosen because one objective of a graduate program is to facilitate critical thinking and transformative learning. The question ofhow adult learners perceive and experience learning steered the direction ofthis study. However, the purpose ofthis research was to study critical incidents that led to profound cognitive and affective changes as perceived by the graduate students. Specifically, the questions to be answered were what critical incidents happened to graduate students while in the Master ofEducation program, how were the incidents experienced, and what transformation resulted? The research design evolved over the course of a year and was highly influenced by previous empirical studies and criticisms oftransformative learning theory. The overall design was qualitative and phenomenological. A critical and interpretive approach was made to empirical data collected through a critical incident questionnaire and in-depth interviews. Inductive analysis allowed theory to be built from the data by making comparisons. New questions emerged and attention was given to social context, the passage oftime, and sequence ofevents in order to give meaning and translation ofthe participants' experiences and to build the interpretive narratives. Deductive analysis was also used on the data and a blending ofthe two forms of analysis; this resulted in the development ofa foundational model for transformative learning to be built.The data revealed critical incidents outside ofthe graduate school program that occurred in childhood or adult life prior to graduate school. Since context of individuals' lives had been an important critique of past transformative learning models and studies, this research expanded the original boundaries of this study beyond graduate school to incorporate incidents that occurred outside of graduate school. Critical incidents were categorized into time-related, people-related, and circumstancerelated themes. It was clear that participants were influenced and molded by the stage oftheir life, personal experiences, familial and cultural conditioning, and even historic events. The model developed in this document fiom an overview ofthe fmdings identifies a four-stage process of life difficulty, disintegration, reintegration, and completion that all participants' followed. The blended analysis was revealed from the description ofhow the incidents were experienced by the participants. The final categories were what were the feelings, what was happening, and what was the enviromnent? The resulting transformation was initially only going to consider cognitive and affective changes, however, it was apparent that contextual changes also occurred for all participants, so this category was also included. The model was described with the construction metaphor of a building "foimdation" to illustrate the variety of conditions that are necessary for transformative learning to occur. Since this was an exploratory study, no prior models or processes were used in data analysis, however, it appeared that the model developed from this study incorporated existing models and provided a more encompassing life picture oftransformative learning.

Knowledge and attitudes of Registered Nurses toward pain /

This research provided relevant data to support pain research literature that finds nurses do not have the knowledge base that they require to sufficiently provide effective pain management. The data demonstrated that nurses have mixed attitudes toward pain. These two findings have been observed in the literature for more than 20 years, but were important results for the hospitals and the nurses involved in the study. The purposes of this study were to identify the level of knowledge and attitudes in a sample of nurses fi-om the surgical and medical units in three hospitals, and determine whether a difference between these two groups existed. The institutional resources to support pain relief practices provided by each hospital were also documented. Data were collected using a convenience sample from the medical and surgical units of three hospitals. Ofthe 1 13 nurses who volunteered to participate, 78 worked in surgical units and 35 worked in medical units. Demographic data were collected about the participants. The established instruments used to obtain data about knowledge and attitude included: (a) Nurses Knowledge of Pain Issues Survey, (b)Attitude to Pain Control Scale, and (c) Andrew and Robert Vignette. Data collected were quantitative along with two open-ended questions for a rich, qualitative section. Inadequate knowledge and outdated attitudes were very evident in the responses. Data from the open-ended questions described how nurses assessed pain and the most conmion problems caring for patients in pain. Nursing practice implications for these hospitals involve initiating a process to develop an educational pain program for nurses throughout the hospital. Utilizing findings from other studies, the program should have an interdisciplinary approach to the planning, implementation, evaluation, and ongoing support. This study supports the belief that inadequate pain management has been attributed to many factors, most importantly to a lack of knowledge. Pain is a costly, unnecessary complication for the patient as well as the hospital. It follows then, that it is in the best interest of all involved to implement an educational pain program in order to influence practice.

What's the difference under the gown? : new professors' development as university teachers

This study explores how new university teachers develop a teaching identity. Despite the significance ofteaching, which usually comprises 40% of a Canadian academic's workload, few new professors have any formal preparation for that aspect of their role. Discipline-specific education for postsecondary professors is a well-defined path; graduates applying for faculty positions will have the terminal degree to attest to their knowledge and skill conducting research in the discipline. While teaching is usually given the same workload balance as research, it is not clear how professors create themselves as teaching professionals. Drawing on Kelly's (1955) personal construct theory and Kegan's (1982, 1994) model ofdevelopmental constructivism through differentiation and integration, this study used a phenomenographic framework~(Marton, 1986, 1994; Trigwell & Prosser, 1996) to investigate the question of how new faculty members construe their identity as university teachers. Further, my own role development as researcher was used as an additional lens through which to view the study results. The study focused particularly on the challenges and supports to teaching role development and outlines recommendations the participants made for supporting other newcomers. In addition, the variations and similarities in the results suggest a developmental model to conceptions ofteaching roles, one in which teaching, research, and service roles are viewed as more integrated over time. Developing a teacher identity was seen as a progression on a hierarchical model similar to Maslow's (1968) hierarchy of needs.

The impact of scheduling on the implementation of the new Ontario curriculum: teachers' perceptions /

This qualitative study explored secondary teachers' perceptions of scheduling in relation to pedagogy, curriculum, and observation of student learning. Its objective was to determine the best way to organize the scheduling for the delivery of Ontario's new 4-year curriculum. Six participants were chosen. Two were teaching in a semestered timetable, 1 in a traditional timetable, and 3 had experience in both schedules. Participants related a pressure cooker "lived experience" with weaker students in the semester system experiencing a particularly harsh environment. The inadequate amount of time for review in content-heavy courses, gap scheduling problems, catch-up difficulties for students missing classes, and the fast pace of semestering are identified as factors negatively impacting on these students. Government testing adds to the pressure by shifting teachers' time and attention in the classroom from deeper learning to a superficial coverage of material, from curriculum as lived to curriculum as text to be covered. Scheduling choice should be available in public education to accommodate the needs of all students. Curriculum guidelines need to be revamped to reflect the content that teachers believe is necessary for a successful course delivery. Applied level courses need to be developed for students who are not academically inferior but learn differently.

Attitudes of second year diploma nurses in three community colleges toward the use of computers in the nursing role /

The effectiveness of various kinds of computer programs is of concern to nurse-educators. Using a 3x3 experimental design, ninety second year diploma student nurses were randomly selected from a total population at three community colleges in Ontario. Data were collected via a 20-item valid and reliable Likert-type questionnaire developed by the nursing profession to measure perceptions of nurses about computers in the nursing role. The groups were pretested and posttested at the beginning and end of one semester. Subjects attending College A group received a computer literacy course which comprised word processing with technology awareness. College B students were exposed to computer-aided instruction primarily in nursing simulations intermittently throughout the semester. College C subjects maintained their regular curriculum with no computer involvement. The student's t-test (two-tailed) was employed to assess the attitude scores data and a one-way analysis of variance was performed on the attitude scores. Posttest analysis revealed that there was a significant difference (p<.05) between attitude scores on the use of computers in the nursing role between College A and C. No significant differences (p>.05) were seen between College B and A in posttesting. Suggestions for continued computer education of diploma student nurses are provided.

An exploratory study of nurses' perceptions of their action learning experience /

Each year, the College of Nurses of Ontario (CNO) requires all registered nurses and registered practical nurses in Ontario to complete a Reflective Practice learning activity. In doing so, nurses are expected to perform a self- assessment, identify a practice problem or issue, create and implement a personal learning plan, and evaluate the learning and outcomes accomplished. The process and components of CNO's Reflective Practice program are very similar to an Action Learning activity. The purpose of this qualitative research was to explore the perceptions of 1 1 nurses who completed at least 1 Action Learning activity. Data analysis of their comments provided insight into their perceptions of the Action Learning experience, perceptions of the negative and positive characteristics of various activities within the Action Learning process, and perceptions of barriers or challenges within this experience. The author concluded that participants perceived their Action Learning activities to be a positive experience because the process focused on practice problems and issues, enhanced thinking about practice problems, and achieved practice-relevant outcomes. However, the results indicated that self-directed learning and journal writing were difficult activities for some participants, and some experienced negative emotional responses during reflection. The research concluded that barriers to implementation of Action Learning include a lack of understanding of the process and a perceived lack of support from employers.

Construing social dimensions of personality development: nurses as educators

A convenience sample of twenty registered nurses was recruited from two' general hospitals and two community college nursing schools. Kelly's (1955) Personal Construct Theory provided the theoretical framework to discover how nurses perceived themselves as educators. The nurses completed a self-administered Self-Perception Inventory (Soares, 1983) to determine their perception of self as nurse and ideal self as nurse. In an interview, each of the nurses constructed a rank-order repertory grid adapted from Kelly's (1955) Role Repertory Construct Test. Twelve constructs derived from the Self-Perception Inventory (Soares, 1983) were ranked according to a list of ten elements common to a teaching situation. Rank order correlations among the constructs were determined with Spearman's rho. Using a dependent samples t-test, significant differences were found between perceptions of current and ideal self for staff nurses. Significant differences were also found between nurse educators' perceptions of self and ideal self as nurse. No significant differences were determined in perceptions of self as nurse and ideal self as nurse between the staff nurse and nurse educator groups with an independent samples t-test. However, observations of single constructs revealed that although several constructs are shared between the groups in the perception of self in a teaching situation, both groups hold constructs that operate exclusively in their separate domains. The nature and strength of the relationships between the common and unique constructs are different for each group. Nurses I self-perceptions appear to be influenced by the historical development of nursing, role socialization during nursing education, social expectations and gender issues in the health care system.