The treatment of PTSD in refugees and asylum seekers using imagery rescripting within an NHS setting.

BACKGROUND: Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service. AIMS: To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers. METHOD: Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression. RESULTS: Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors. CONCLUSIONS: Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.

Nursing staffs' emotional well-being and caring behaviours.

AIMS AND OBJECTIVES: To examine the relationships between structural factors (work stressors), individual factors (demographics and the personal resources of resilience and social support) and transactional factors (appraisals and coping), and nursing staffs' levels of burnout, psychological distress and caring behaviours. A further aim was to examine the relationships between nursing staffs' levels of burnout and psychological distress and their caring behaviours. BACKGROUND: Burnout and psychological distress levels have been found to be high in National Health Service nursing staff and furthermore this emotional distress has been found to affect patient care. In a National Health Service striving to provide high-quality patient-centred care, it is essential that factors affecting nursing staffs' well-being and their caring behaviours are examined. DESIGN: A cross-sectional correlation-based survey design. METHODS: A sample of 102 nursing staff from an Acute National Health Service Trust were recruited in 2010. Participants completed the questionnaires: Nursing Stress Scale, Social Support Questionnaire-Short Form, Connor and Davidson Resilience Scale-2, Occupational Coping Self-Efficacy Scale for Nurses, PsychNurse Scale, Maslach Burnout Inventory, The Hospital Anxiety and Depression Scale and Caring Behaviours Inventory-revised. Due to the nonparametric nature of part of the data, Spearman's Rho correlations were used for analysis. RESULTS: Demographics were not found to be regularly correlated with nursing staffs' burnout, psychological distress or caring behaviours. Work stressors, coping strategies and self-efficacy were found to be significantly correlated with nursing staffs' burnout and psychological distress. Caring behaviours were also correlated with coping strategies and self-efficacy. Importantly, correlations were found between caring behaviours and nursing staffs' burnout and psychological distress. CONCLUSION: It is extremely important that the emotional well-being of nursing staff is supported, both for them, and for the effect this has on patient care. Action points are suggested for National Health Service employers to enable this to happen. RELEVANCE TO CLINICAL PRACTICE: To address the poor emotional well-being found, it is suggested that changes are needed within current clinical practice, for example through provision of enhanced training, use of model-based clinical supervision and reviews conducted on staffing levels and workload issues.