Self-Compassion, Minority Stress, and Mental Health in Sexual and Gender Minority Populations: A Meta-Analysis and Systematic Review.

Sexual and gender minority (SGM) populations report numerous mental health disparities relative to heterosexual and cisgender populations, due in part to the effects of minority stress. This article evaluated self-compassion as a coping resource among SGM populations by (a) meta-analyzing the associations between self-compassion, minority stress, and mental health; and (b) synthesizing evidence for the mediating effects of self-compassion between minority stress and mental health. Systematic searches of databases identified 21 papers for the systematic review and 19 for the meta-analysis. Significant meta-analytic associations were found between self-compassion and minority stress (n = 4,296, r = -.29), psychological distress (n = 3,931, r = -.59), and well-being (n = 2,493, r = .50). The research synthesis identified supporting evidence for self-compassion as a coping resource for SGM people. The results of this review warrant further self-compassion research, particularly longitudinal research, for SGM populations.

Transgender and Gender Diverse Fertility Choices: Supporting the Decision-Making Process for Adolescents and Young Adults.

OBJECTIVE: To qualitatively examine the fertility-related decision making process of transgender and gender diverse (TGD) adolescents and young adults (AYAs) and their parents, in the setting of pursing gender affirming treatments. STUDY DESIGN: Twenty-five TGD AYAs and 6 parents of TGD AYAs participated in a focus group or individual semistructured interviews focused on participants' experience learning about the effects of gender affirming treatments on fertility as well as the process of making a fertility preservation decision. Using open coding, data were analyzed in an iterative process identifying emerging themes and relationships. A decisional satisfaction score was collected and/or coded for each participant. RESULTS: Four broad themes related to the decision-making process were identified: (1) Critical steps include awareness, gathering information, and conversations; (2) External constraints limit choices; (3) Expanding the conversation beyond preservation; and (4) Emotional distress, conflict, and decisional satisfaction. Despite reporting emotional distress or conflict during the decision, TGD AYAs and parents of TGD AYAs generally reported a high level of satisfaction with their fertility preservation decision. CONCLUSIONS: There are specific ways health care professionals and family members can support TGD AYAs in their fertility-related decision making process. Decisional satisfaction was common, regardless of whether TGD AYAs chose to pursue fertility preservation or not.

Mindfulness for healthcare providers fosters professional quality of life and mindful attention among emergency medical technicians.

OBJECTIVE: Emergency medical service (EMS) providers are systematically subjected to intense stimuli in their work that may result in distress and emotional suffering. While it is known that mindfulness-based stress reduction (MBSR) helps to foster well-being in healthcare workers, the effectiveness of MBSR among EMS providers is less understood. We explored the impact of a modified version of MBSR for healthcare workers called Mindfulness for Healthcare Providers (MHP) on reducing distress and promoting wellbeing in EMS providers. METHODS: A one-arm pilot study was conducted. We implemented eight two-and-a-half hour sessions of Mindfulness for Healthcare Providers with an additional day-long retreat at the end. Feasibility, perceived stress, professional quality of life, and trait mindfulness were assessed prior to and after the intervention. The professional quality of life scale includes measures of compassion satisfaction, burnout, and secondary trauma. RESULTS: Fifteen veteran EMS providers enrolled in the course; four participants dropped out. Prior to initiation of the study, no significant differences were revealed between those who did not participate (n = 48) and those who did (n = 11). After the intervention EMS providers endorsed statistically significant increases in compassion satisfaction, trait mindfulness, and decreases in burnout compared to the beginning of the program. These changes were sustained at six months post-completion. No significant changes over time were found for secondary trauma or perceived stress. CONCLUSIONS: To our knowledge, this study is the first to employ Mindfulness for Healthcare Providers in an EMS population and to demonstrate a positive impact on self-reported compassion, trait mindfulness, and burnout in this population. Additional research regarding mindfulness training within EMS populations should be conducted to further understand the relationship between mindfulness and perceived stress over time.

Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study.

OBJECTIVE: The Pause is a short-term, microbreak created by an emergency nurse in 2009. It provides care team members a few seconds of silence to honor a patient who has died while also honoring the efforts of the team. It is used now on four continents as a standard of care. We investigated how it is being used and why. METHODS: We used a modified Delphi methodology with purposive sampling and a descriptive approach. During the three-round Delphi, we created a data display using open, then axial coding to develop a thematic analysis. Member checking and reflexivity exercises were used to build reliability and trustworthiness of findings. RESULTS: We analyzed 21 transcripts. The Pause is reported to be an ongoing practice in at least 23 health systems globally. Key themes such as Benefits, Self-Care, and Support of other Patients were most pertinent in our analysis. CONCLUSION: The Pause is a low-risk, grassroots intervention that can be led by any member of a care team in emergency settings. It offers self-care for the individual and team. It helps emergency providers feel grounded after a death before going to treat another patient. According to our sample, The Pause helps reduce caregiver stress, which may decrease the risk for burnout. Although further research is recommended, we assert that The Pause be used as a standard of care in emergency departments across the United States.

"The Pause": A Delphi Methodology Examining an End-of-Life Practice.

"The Pause" was first practiced by a nurse at a Level 1 trauma center to honor the death of a deceased patient. This practice has spread internationally and is used in emergency departments, intensive care, transplant, and oncology units, in addition to pre-hospital settings. There is a paucity of research published on the effects of The Pause for health care workers. We used a three-staged Delphi methodology to understand the barriers, benefits, and language used in The Pause. Analyses of email communication and interview transcripts suggest that The Pause poses minimal risk and has considerable benefits. Benefits include increased perceived team cohesion, a moment for reflection, and a method by which to honor a deceased patient. The Pause allows nurses to feel more present to meet the needs of the next patient they care for during a shift. Further research is merited.

Impact of Coping and Communication Skills Program on Physician Burnout, Quality of Life, and Emotional Flooding.

BACKGROUND: Physician behaviors that undermine a culture of safety have gained increasing attention as health-care organizations strive to create a culture of safety and reduce medical errors. We developed, implemented, and assessed a course to teach physicians skills regarding effective coping and interpersonal communication skills and present our results regarding outcomes. METHODS: We examined a professional development program specifically designed to address unprofessional or distressed behaviors of physicians, and we evaluated the impact on burnout, quality of life, and emotional flooding scores of the physicians. Assessments of burnout, quality of life, and emotional flooding were assessed preintervention and postintervention. RESULTS: Results demonstrated statistically significant reductions over time in physicians' emotional flooding and emotional exhaustion (EE). Specifically, using a Wilcoxon Signed-Rank test, results revealed that flooding scores at follow-up were statistically significantly lower than at baseline, V = 590, p < 0.05, and EE and personal accomplishment distributions were found to significantly deviate from normal as indicated by Shapiro-Wilks tests (p < 0.05). A Wilcoxon signed-rank test indicated that EE scores were significantly higher at baseline compared to follow-up 1, V = 285, p < 0.05. CONCLUSION: We conclude that the physician participants who enrolled in the educational skills training program improved scores on emotional flooding and EE and that this may be indicative of improved skills related to their experiences and learning in the program. These improved skills in physicians may have a positive impact on the overall culture of safety in the health system setting.

Variability of Diabetes Alert Dog Accuracy in a Real-World Setting.

BACKGROUND: Diabetes alert dogs (DADs) are growing in popularity as an alternative method of glucose monitoring for individuals with type 1 diabetes (T1D). Only a few empirical studies have assessed DAD accuracy, with inconsistent results. The present study examined DAD accuracy and variability in performance in real-world conditions using a convenience sample of owner-report diaries. METHOD: Eighteen DAD owners (44.4% female; 77.8% youth) with T1D completed diaries of DAD alerts during the first year after placement. Diary entries included daily BG readings and DAD alerts. For each DAD, percentage hits (alert with BG ≤ 5.0 or ≥ 11.1 mmol/L; ≤90 or ≥200 mg/dl), percentage misses (no alert with BG out of range), and percentage false alarms (alert with BG in range) were computed. Sensitivity, specificity, positive likelihood ratio (PLR), and true positive rates were also calculated. RESULTS: Overall comparison of DAD Hits to Misses yielded significantly more Hits for both low and high BG. Total sensitivity was 57.0%, with increased sensitivity to low BG (59.2%) compared to high BG (56.1%). Total specificity was 49.3% and PLR = 1.12. However, high variability in accuracy was observed across DADs, with low BG sensitivity ranging from 33% to 100%. Number of DADs achieving ≥ 60%, 65% and 70% true positive rates was 71%, 50% and 44%, respectively. CONCLUSIONS: DADs may be able to detect out-of-range BG, but variability across DADs is evident. Larger trials are needed to further assess DAD accuracy and to identify factors influencing the complexity of DAD accuracy in BG detection.