Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study.

BACKGROUND: The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak. METHOD: We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis. RESULTS: The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks. CONCLUSION: High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.

Exploring the Occupational Lifestyle Experiences of the Families of Public Safety Personnel.

PURPOSE: Public safety personnel, including first responders, are regularly exposed to physical, social, and psychological risks and occupational requirements. These risks and requirements extend beyond the employee and may also impact the families (for example, work-family conflict, compassion fatigue). Despite recent attention directed at the population's wellness, considerably less attention is directed towards the family. This review investigates how the risks and requirements associated with these occupations affect families' lives and experiences, and correspondingly, how families respond and adapt to these risks. METHODS: In the current qualitative review, we sought to identify and describe the lifestyle experiences of public safety families as they navigate the occupational risks and requirements of public safety work. The inclusion criteria resulted in an analysis of 18 articles, representing only police (n = 11), paramedics (n = 7), and firefighting (n = 10) sectors. RESULTS: We identified and described the experiences of public safety families both by occupation and familial role. Shared familial themes across occupational groups included 'Worry', 'Communication', 'Where do I turn', 'Are they okay', 'Serving alongside', and '(Over)Protective'. However, distinct themes also emerged between different occupational groups and family configurations. Themes prevalent amongst primarily children of police included: 'Worry', 'Let's Laugh Instead', '(Over)Protective', and 'I'm not the Police, my Parent is!'. Experiences differed if the family contained on serving public safety personnel or multiple. CONCLUSION: We identified the shared and unique occupational experiences of public safety families. This review normalizes these experiences and emphasizes the need to develop initiatives to improve the well-being of families and safety employees.

Exploration of note writing by mental health nurses using a video scenario.

AIMS AND OBJECTIONS: We aimed to explore the content and language of nursing documentation and gain insight into the internal processes of nurses while notetaking. BACKGROUND: Documentation is a core competency of mental health nursing, has clinical and ethical importance and is the integral to the efficient and effective care provided to patients. However, issues related to the content and quality of nursing notes continues to be a concern and there remains gaps in our understanding about the internal processes that nurses engage in when writing notes. DESIGN: We used a mixed method design that included a content analysis with note review and interviews. METHODS: After watching a video, psychiatric nurses (n = 27) wrote a note and then were interviewed about their note taking process. We used the COREQ guidelines for reporting our data. RESULTS: Participants relied on four main themes when determining what to include in their notes-what happened and what the patient said or did, plus anything different than baseline, and safety concerns. Analyses revealed the presence of bias in the notetaking and participants were not familiar with effective strategies to mitigate these during the documentation process. Lastly, we found that notes are typically consistent in using some of the SOAPE format with notes focused on direct observations and the use of 'facts', while assessment and construction of treatment plans are used to a lesser extent. CONCLUSIONS: Our results provide insight into the decision-making process of nursing staff regarding their documentation practices: overall they appear unaware of the importance of their notes, and believe that capturing the facts about their patients is important, while devaluing their own input and interpretations. RELEVANCE TO CLINICAL PRACTICE: Our results provide evidence that mental health nurses may need additional training regarding documentation, more specifically about what to include, word choice and bias.

Sources of stress among Federal Correctional Officers in Canada.

Most correctional officers describe their jobs as stressful. The current study advances the scholarship on correctional stress by offering a rare qualitative analysis that identifies, provides meaning, and contextualizes sources of stress in correctional services. This study complements the correctional stress literature, which, until now, has relied primarily on quantitative methodologies to identify and assess stress determinants. Forty-four correctional officers from Canada's federal prisons were interviewed about their primary source of stress. Findings indicate that staff (i.e., co-workers and managers), not prison residents, represent a primary source of stress in correctional work. In addition, job seniority and gossip were the main stress triggers associated with co-workers, while centralization of decision-making processes and a lack of instrumental communication and support triggered stress coming from managers.

The Floating Signifier of 'Safety': Correctional Officer Perspectives on COVID-19 Restrictions, Legitimacy and Prison Order.

The COVID-19 pandemic continues to affect prisons internationally. Existing research focuses on infection data, meaning we do not fully understand how COVID-19 shapes frontline prison dynamics. We draw on qualitative interviews with 21 Canadian federal correctional officers, exploring how the pandemic impacted prison management. Officers suggested inconsistent messaging around COVID-19 protocols reduced institutional and officers' self-legitimacy, fracturing trust relationships with incarcerated people. Furthermore, officers suggest that personal protective equipment such as gowns and face shields took on multiple meanings. We use Lévi-Strauss' floating signifier concept to analyse how individual definitions of 'safety' informed day-to-day prison routines. We conclude by arguing that legitimacy deficits and contested definitions of 'safety' will continue to create uncertainty, impacting prison operations going forward.

Fight or flight? Exploring suicide thoughts, experiences, and behaviours among correctional workers and their interventions of agency.

Research indicates that, relative to the general public and most other types of public safety personnel, correctional workers are more likely to engage in suicide ideation, planning, and attempts. Yet, less is known about lived experiences towards, of, and beyond suicidality among correctional staff. To contribute to this gap in knowledge, the current study draws on qualitative, open-ended survey response data (n = 94) to explore how Canadian provincial correctional workers navigate experiences of suicide, with a focus on the individual, personal, and social factors tied to experiences towards and of suicide thoughts and behaviours. By engaging the seminal works of Foucault, Zizek, and Deleuze and Guattari, we explore respondents' distinct forms of agency when grappling with, challenging, and transcending thoughts around suicide. We then discuss the research implications, with an emphasis on providing correctional workers with confidential, non-stigmatised well-being and treatment-seeking resources and processes, and more health care funding to fully cover timely and sufficient mental health treatment, prevention, and intervention.

Exposures to Potentially Psychologically Traumatic Events Among Provincial Correctional Workers in Ontario, Canada.

We know little about potentially psychologically traumatic events (PPTE) exposures among provincial correctional workers in diverse occupational positions and even less regarding how exposure to events are associated with mental health disorders. We designed the current study to unpack and quantify estimates of the frequencies that correctional workers, across occupational roles, experience exposure to diverse incidents. We categorized 1,338 of our 1,487 participants into six occupational categories and our measures included established self-report items measuring PPTE exposure and mental disorder symptoms. Almost all correctional workers reported exposures to most PPTE types. Correctional workers collectively report exposures to physical assault (90.2%) and sudden violent death (81.8%), with many (3.1%-46%) reporting 11+ exposures (M = 10.01, SD = 4.29). We found significant differences in exposure patterns across correctional worker categories; specifically, we found a higher prevalence of exposure to toxic substances, physical assault, assault with a weapon, severe human suffering, sudden accidental or sudden violent death, among those working in institutional correctional services (e.g., governance, correctional officers). PPTE exposure and all assessed mental health disorder symptom profiles were closely related, as correctional workers report high exposure to PPTE. Population attributable fractions indicated that the burden of mental disorders among provincial correction workers might be reduced by between 38%-70% if PPTE exposures were eliminated from the population. We conclude with recommendations for mental health related policies, such as investing in peer and psychologically support, as well as interventions for exposure to PPTE and readiness to inform strategies for employee mental health and well-being.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study.

AIM: We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. BACKGROUND: Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. METHODS: We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. RESULTS: We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. CONCLUSION: Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

Perceptions of Workplace Violence and Workplace Stress: A Mixed Methods Study of Trauma among Psychiatric Workers.

Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.

'We're both here to do a job and that's all that matters': Cisgender correctional officer recruit reflections within an unsettled correctional prison culture.

Reflecting on new trans prisoner placement policies within Canadian federal prisons, in light of recent changes instigated under the Canadian Liberal Trudeau government, we provide knowledge from cisgender correctional officer (CO) recruits regarding these policy changes and underscore their views of working with officers who identify as transgender. Canada's new policies recognize the presence of trans prisoners and create new protocols accordingly, simultaneously challenging some of the foundational tenets of the carceral system. While overwhelming support exists from cisgender recruits for their trans colleagues, support among a relative minority of COs is contingent upon notions like safety and security grounded in a dominantly cisgender prison culture; a culture we situate within the wider context of an unsettled correctional prison culture.

A Cross-Sectional Study of the Relationship between Previous Military Experience and Mental Health Disorders in Currently Serving Public Safety Personnel in Canada.

OBJECTIVE: There is an increased incidence of some mental health disorders such as post-traumatic stress disorder (PTSD) in some members of the military and in some public safety personnel (PSP) such as firefighters, police officers, paramedics, and dispatchers. Upon retirement from the armed forces, many individuals go on to second careers as PSP. Individuals with prior military experience may be at even greater risk than nonveterans for developing mental health disorders. The present study was designed to examine the relationship between prior military service and symptoms of mental health disorders in PSP. METHODS: This is a cross-sectional, observational study. Data for this study were collected from an anonymous, web-based, self-report survey of PSP in Canada. Invitations to participate were sent to PSP via their professional organizations. Indications of mental disorder(s) and symptom severity were assessed using well-validated self-report screening measures. RESULTS: Of the survey respondents who provided this information, 631 (6.8%) had prior armed forces experience; however, not all responses were complete. Ex-military PSP reported significantly more exposure to traumatic events and were approximately 1.5 times more likely to screen positive for indications of PTSD, mood, anxiety, or acute stress disorders and to have contemplated suicide than those without prior armed forces experience. CONCLUSIONS: In our study, individuals in PSP with prior service experience in the armed forces were more likely to screen positive for indicators of some mental health disorders. Accordingly, mental health practitioners should inquire about previous service in the armed forces when screening, assessing, and treating PSP.

Mental health training, attitudes toward support, and screening positive for mental disorders.

Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43-60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.

How forensic mental health nurses' perspectives of their patients can bias healthcare: A qualitative review of nursing documentation.

AIMS AND OBJECTIVES: Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. BACKGROUND: Clinicians are responsible to document and record accurately. However, nurses' attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients' care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. DESIGN: This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. METHODS: We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. RESULTS: The results highlight some evidence of nurses' empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. CONCLUSIONS: When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. RELEVANCE TO CLINICAL PRACTICE: Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation.

How "Conditions of Confinement" Impact "Conditions of Employment": The Work-Related Well-Being of Provincial Correctional Officers in Atlantic Canada.

Internationally, researchers studying correctional officer (CO) work have examined CO self-presentation, staff-prisoner relationships, and emotional labor. We build on this research by drawing on occupational literature to examine officer mental health outcomes that result from correctional work. We examine the impact of working in prison on COs' well-being, paying particular attention to aspects of the work content (operational stressors) and context (organizational stressors). In conducting semi-structured interviews with COs in Atlantic Canada, we found that COs identified a number of operational stressors as impacting their mental health, specifically generalized violence among prisoners, direct and vicarious violence, and ongoing harassment. COs identified organizational stressors, including a work culture that discourages visible emotional responses to operational stressors, a lack of support from management, and inadequate procedures for dealing with workplace violence and harassment, as factors that exacerbate and contribute to negative mental health outcomes.

Women parolees' mental health in the context of reintegration.

BACKGROUND: Contributing to the literature on reintegration and community supervision, we consider the mental health experiences of women parolees and the implications for case management. AIMS: We consider the different ways mental health considerations are responded to by parole officers and case management staff, identifying areas of tension (e.g., when psychological services are fused with supervision) but also areas of opportunity (e.g., when case management staff forge therapeutic relationships with parolees). METHODS: Using a grounded approach we explore women's parole experiences and case management practices through a qualitative analysis of parole and casework documents. Our iterative process of document analysis included content and thematic analysis. RESULTS: Mental health is responded to both as a therapeutic need and criminogenic risk. Therapeutic responses entail both formal and informal supportive interventions that often appear welcomed by and beneficial to parolees. Risk-based responses fuse mental health considerations into supervisory frameworks, evidenced by the prominence of mental health-related parole conditions and the role of psychologists as assessors of risk. CONCLUSIONS/IMPLICATIONS FOR CLINICAL PRACTICE: The tension between treatment and supervision can undermine conditions favourable to responsive case management and the working alliance.

Sport, Physical Activity, and Young People Who Are Incarcerated: A Scoping Review.

We present a scoping review of qualitative scholarly publications on sport and physical activity in secure custody facilities for young people published over a 22-year period, finding the literature remains geographically, substantively, and theoretically scant. We identify and assess predominant themes in the following four areas: (1) sport's potential contribution to young persons' rehabilitation and desistance; (2) the structure and organization of sport programs; (3) sport and coping with the experience of incarceration; and (4) other themes, including health outcomes and gender and race. Our scoping review provides a foundation for researchers and policymakers to advance knowledge about sport-based interventions in the lives of young people who are incarcerated.

"I feel like it should be but I know it's really not": exploring physical fitness priorities at the correctional training program in Canadian federal corrections.

The correctional training program (CTP), composed of three stages, includes a 14 week in-person component that Correctional Officer Recruits (CORs) must complete prior to their employment as a federal Correctional Officer (CO) for Correctional Service Canada (CSC). The CTP prepares recruits for a plethora of CO responsibilities, some dependent on physical fitness, such as responding to codes being called, physical altercations, or violent situations. Unlike other public safety positions (e.g. policing, border services, or coast guard) CSC does not require occupational fitness testing. In the current article, we use data from a multiyear longitudinal study of federal COs from across Canada to unpack how CORs manage physical fitness expectations at CTP; CSCs' expectations of COR physical fitness; and outline what types of physical fitness (e.g. weightlifting, cardiovascular, self-defence) are taught, thus valued most, during CTP. We situate the voices of CORs regarding physical fitness within the broader "body" literature and discuss policy recommendations tied to physical fitness, specifically COs' interest in reinstating pre-employment physical fitness screening.

Exploring the impacts of COVID-19 on Alberta correctional workers.

COVID-19 and the subsequent public health responses disrupted the routines and lives of people globally. The impact was felt by correctional workers who navigated rapidly changing public health policies and many disruptions to operations within both institutional and community correctional services. In the current study, we unpack qualitative findings emerging from an online mental health and well-being survey, during COVID-19, of 571 correctional workers employed in the Canadian province of Alberta. Results emphasize how correctional work was strained by the on-set of the COVID-19 pandemic, creating other risks and vulnerabilities for both staff and incarcerated people. Respondents highlighted impacts to their workload, routine, personal and institutional security, relationships with colleagues and incarcerated people, and their competing perspectives on the enforcement and ethics of ensuing public health measures intended to contain the spread of the virus. We discuss the empirical implications of these findings and areas for future research post pandemic.

Correctional Transgender Policy in Canada's Federal Prison System.

Since December 2017, Canada's federal correctional system provides prisoners the opportunity to be assigned to living units according to their self-identified gender. Still organized around sex, conceptually and spatially, prison policies and procedures surrounding transgender prisoners require navigation to adhere to the rights of all prisoners. Based on interviews conducted between October 2019 and October 2021 with 74 correctional officers (COs) from the Canadian federal prison system, we discuss how correctional officers view and operationalize Canada's transgender policy to understand its unintended consequences for both prisoners and prison staff. Unintended consequences revolve around the potential risk for prisoner victimization, prisoner pregnancy, lack of adequate housing, strip search complications, officers' fear of being labeled transphobic, and uncertainty and discretion; all having effects on staff wellness. The policy, although well-intended, may potentially compromise prisoner safety, making correctional work even more stressful.

"We must be mentally strong": exploring barriers to mental health in correctional services.

Introduction: The inherent nature of work in correctional services can have negative effects on correctional worker mental health and well-being. Methods: The current study, a replication, analyzes survey data collected from provincial and territorial correctional workers staffed in six regions across Canada (n = 192). Specifically, participants were asked at the end of an extensive mental health and well-being survey an open-ended question requesting any additional feedback or information. Results: Four predominant themes were identified in the data: (1) stigma pertaining to a need to recognize mental health concerns within correctional services; (2) the idea that correctional services wear on the mind and body; (3) a need for better relationships with and support from correctional supervisors, upper management, and ministerial leadership; and (4) suggestions to improve correctional services to help the sector realize its full potential and maximize workplace health. Discussion: We discuss the implications of these findings, with an emphasis on finding ways to promote positive organizational and cultural change in correctional services.