Institutional Betrayal and Gaslighting: Why Whistle-Blowers Are So Traumatized.

Despite whistle-blower protection legislation and healthcare codes of conduct, retaliation against nurses who report misconduct is common, as are outcomes of sadness, anxiety, and a pervasive loss of sense of worth in the whistle-blower. Literature in the field of institutional betrayal and intimate partner violence describes processes of abuse strikingly similar to those experienced by whistle-blowers. The literature supports the argument that although whistle-blowers suffer reprisals, they are traumatized by the emotional manipulation many employers routinely use to discredit and punish employees who report misconduct. "Whistle-blower gaslighting" creates a situation where the whistle-blower doubts her perceptions, competence, and mental state. These outcomes are accomplished when the institution enables reprisals, explains them away, and then pronounces that the whistle-blower is irrationally overreacting to normal everyday interactions. Over time, these strategies trap the whistle-blower in a maze of enforced helplessness. Ways to avoid being a victim of whistle-blower gaslighting, and possible sources of support for victims of whistle-blower gaslighting are provided.

What neonatal intensive care nurses need to know about neonatal palliative care.

The purpose of this study was to identify and prioritize topics for a professional development program in neonatal palliative care. A total of 276 nurses and midwives who work in an Australian neonatal intensive care unit (NICU) and 26 international healthcare professionals working in NICU and palliative care served as participants. A Delphi technique was used, consisting of a series of rounds of data collection via interview and questionnaire, to identify and consolidate opinions of nurses and other healthcare professionals who work in neonatal intensive care units. The main outcome measures were: (1) Topics to be included in a professional development program for nurses working in neonatal intensive care units and (2) the preferred format of the program. Twenty-three high-priority topics were identified, which included preparing families when death is imminent, how to provide emotional support to grieving parents, advocating for a dying baby, and assessing and managing pain in a dying baby. Care of a dying infant requires the same skill set as caring for older terminally ill children internationally. A combination of face-to-face lectures and interactive workshops using case studies and audiovisual examples is the preferred format.

How to create a journal article from a thesis.

AIM: To identify strategies to assist in the publication of research arising from a postgraduate thesis or dissertation. BACKGROUND: There are many benefits to publishing a journal article from a completed thesis, including contributing knowledge to the writer's chosen field, career enhancement and personal satisfaction. However, there are also numerous obstacles for the newly graduated student in crafting an article fit for a specialist publication from a thesis. DATA SOURCES: The author conducted a search of the title, abstract and keywords of the Cinahl, Scopus and Proquest databases, from 1990 to 2010: The author searched for the words: 'journal article' or 'manuscript; 'thesis' or 'dissertation'. REVIEW METHODS: The author excluded papers if: they pertained to allocation of authorship to someone other than the academic adviser; related to undergraduate issues rather than graduate dissertations; were discussions of the merits of a PhD by 'publication' instead of 'by thesis'; were not published in a peer-reviewed journal; or were not in English. CONCLUSION: The relationship between adviser and student changes as the student becomes a graduate, and new roles for the student and adviser need to be negotiated. IMPLICATIONS FOR RESEARCH/PRACTICE: Students need to realise that writing a paper from a thesis is usually going to be more difficult than they anticipate, but the application of strategies discussed in this paper should make the task manageable. Furthermore, universities might wish to consider alternatives in which published papers emerge before the examination of a thesis, such as requiring students to write a paper as part of their coursework.

Informed consent: are researchers accurately representing risks and benefits?

Changes in the scope of health research in the last 50 years require evidence to support assumptions about what constitutes harm and benefit to research participants. The aim of this study was to investigate the actual benefits and harm individuals experienced while participating in potentially distressing qualitative research. Data were collected via semi-structured interviews and subjected to thematic analysis. Five themes emerged: (i) motivation to participate, (ii) expectations of participation, (iii) sources of harm, (iv) mitigating harm and (v) benefits of participation. Results indicated that all participants benefited through participation in the qualitative research. Most participants also reported varying degrees of distress during the interviews, but did not consider this harmful. In contrast, dissemination of the findings did constitute an unexpected source of potential harm for the participants and researcher. It is concluded that for these participants, distress during qualitative interviewing is not in itself harmful, and that participant information sheets need to reflect the harms and benefits of participation more accurately in a user-friendly format. Furthermore, the sensitivity with which research is disseminated needs to be considered as a fundamental protection for participants from unwarranted criticism by third parties. Recommendations include that researchers conducting interviews have specific personal and professional attributes relevant to the participant group, and that transcripts/raw data should not be sent automatically to participants.

Finding a way: the experiences of U.K. educated midwives finding their place in the midwifery workforce in Australia.

BACKGROUND: The number of midwives and nurses migrating from the United Kingdom (U.K.) and seeking registration in Australia is growing annually. Studies examining nurse migration have yet to identify features of the experience that apply specifically to the midwifery workforce. This information is vital to inform future international recruitment practice and to promote midwifery retention. This paper reports on a study examining the experiences of a group of midwives from the United Kingdom settling into the workforce within one state in Australia. DESIGN: This descriptive phenomenological study examined the lived experience of U.K. migrant midwives practising in Queensland using open ended interviews and reflective journaling. Data analysis was conducted following the guidance of Moustakas, adapted from the van Kaam method of analysis of phenomenological data. SETTING: All data gathered from midwives living and working in Queensland. PARTICIPANTS: Midwives (n=18) working in Queensland who had left the U.K. after 1 January 2000. FINDINGS: A central theme emerging from participants' experiences is described as 'finding a way'. Their experience was encompassed in a model of acculturation used by the midwives to find their way through the health-care systems in Queensland to be the kind of midwife that suited them and their life style. The three ways of being were influential association, capitulation and detachment. The most common feature of the experience was that of influential association. KEY CONCLUSIONS: Midwives need to be well informed to provide realistic expectations prior to migration. Recruitment and management personnel should seek to match midwifery capacity with roles where their skills will be maximised.

Stress and coping in Singaporean nurses: a literature review.

Stress is ubiquitous in the nursing profession and is also prevalent in Asian countries, particularly the "four tigers of Asia": Singapore, Hong Kong, Taiwan, and South Korea. Based on the theoretical framework of Lazarus and Folkman (1984), the present review of the nursing literature aims to identify sources and effects of stress in Singaporean nurses and the coping strategies they use. Nurses reported major stressors including shortage of staff, high work demands and conflict at work. Common coping strategies included problem orientation, social support and relaxation techniques. Several studies reported nurses' intent to leave the profession. Recommendations to minimize the impact of stress include in-service programs to facilitate a problem-solving approach to resolving work-related issues such as conflict. Relaxation therapy and debriefing sessions may also help in reducing negative effects of work stressors. Finally, nurses' emotional coping can be enhanced by strengthening sources of social support, particularly from family.

A systematic review: Students with mental health problems--a growing problem.

The number of university students with a serious mental illness has risen significantly over the past few years. A systematic review was conducted that addressed emotional and or mental health problems of university students worldwide. In total, 572 articles were identified, of which 11 met inclusion criteria. Issues identified included types of problems experienced by students, how staff dealt with these students, barriers to seeking help, tools that facilitated help-seeking and epidemiological trends in the university student population. Recommendations include (i) providing better links between the university and external mental health providers, and (ii) increasing students' awareness of existing support services within and external to the university. As it is unrealistic to expect all academic staff to have the expertise required to deal with students with emotional problems, it is also recommended that (iii) policies and personnel with expertise in mental health are available to provide guidance for staff.

"Holding our breath": the experiences of women contemplating nuchal translucency screening.

This article describes the experiences of women who were contemplating nuchal translucency (NT) screening for Down syndrome. Data were collected via semistructured interviews from 20 participants and subjected to a hermeneutic analysis. Findings included that pregnancy was considered to be an essentially abnormal process involving major risks and that being a "good mother" meant rejecting their own mother's advice and keeping quiet about a decision to terminate the pregnancy. Friends played an important role in influencing women to accept NT screening.

Three different ways mental health nurses develop quality therapeutic relationships.

The purpose of this study was to determine if there were different ways in which mental health nurses develop quality therapeutic relationships with patients. A taxonomy of 140 attributes were identified as important to the formation of a quality therapeutic relationship in mental health nursing. These attributes provided the basis for the development of a Q-sort instrument, which was piloted. Results led to the identification of three clusters of mental health nurses who share similar beliefs regarding the attributes required to develop a quality therapeutic relationship with patients. These groupings of attributes were called "Equal Partner," "Senior Partner," and "Protective Partner." Recommendations are provided and include that nurses consider their nursing style in their choice of employment environment and that managers consider their nurses' individual styles in determination of an optimal case mix.

Preparing nurses for practice: a phenomenological study of the new graduate in Australia.

AIMS: To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. BACKGROUND: Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. DESIGN: Husserl's phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. METHODS: Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi-structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. RESULTS: As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for 'bitchiness' and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. CONCLUSIONS: Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. RELEVANCE TO CLINICAL PRACTICE: Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment.

At-risk children: a demographic analysis of the children of clients attending mental health community clinics.

Children of parents with mental illness have an increased risk of psychological problems. The aim of this study was to identify the demographic characteristics of dependent children of adults presenting at mental health clinics in Western Australia. A survey of clients who attended the clinics indicated that half reported having had children. Of these, 21% had a primary diagnosis of schizophrenia. Although schizophrenia was the most common illness, there were almost seven times more children living with a parent with a primary diagnosis of depression than schizophrenia. Recommendations include that children of clients with mental illness be included as part of a wider client focus.

Physical and emotional effects of whistleblowing.

This research examined the stress-induced health effects of whistleblowing and non-whistleblowing on nurses in Western Australia. A descriptive survey design was used to explore the physical and emotional problems experienced by nurses who did and did not blow the whistle on misconduct in the workplace. A questionnaire based on Lazarus and Folkman's Model of Stress and Coping was developed and posted anonymously to general and mental health nurses. Ninety-five nurses responded to the questionnaire, and 70 were identified as whistleblowers and 25 were identified as non-whistleblowers. Results indicated that 70% of whistleblowers and 64% of non-whistleblowers experienced stress-induced physical problems from being involved in a whistleblowing situation. The most common physical problems experienced by nurses were restless sleep, fatigue, headaches, insomnia, and increased smoking. In addition, 94% of whistleblowers and 92% of non-whistleblowers suffered stress-related emotional problems, the most frequent being anger, anxiety, and disillusionment. Whistleblowers and non-whistleblowers suffered a similar percentage of physical health problems, whereas non-whistleblowers suffered a higher percentage of emotional health problems, especially feelings of guilt, shame, and unworthiness. These findings suggest that whistleblowing situations are stressful and may cause physical and emotional health problems whether one blows the whistle or not.