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Palliative Care, Expressive Writing, Resilience, Stress, Compassion satisfaction, Organizational commitment
Background and aim of the work: Palliative Care professionals are exposed to intense emotional environment. This puts them at risk for Compassion Fatigue and Burnout. The protective factors that can counter their onset are Compassion Satisfaction, Organizational Commitment and Resilience. Expressive Writing is a valid tool for adapting to traumatic events and enhancing psychological well-being. Aim of this study is to evaluate the effect of the Expressive Writing in Palliative Care professionals on Compassion Satisfaction, Organizational Commitment, Resilience, Compassion Fatigue and perceived distress. Methods: Prospective experimental study with experimental/control groups and pre/post measurements. 50 Palliative Care professionals were recruited in Northern and Central Italy. Participants filled: Organizational Commitment Questionnaire; ProQol - revision III; Resilience Scale for Adults; Impact of Event-Scale Revised; Emotion Thermometer; ad hoc questionnaire for the evaluation of protocol usefulness. Results: Wilcoxon test demonstrated change in Continuative Commitment (Z = -3.357, p = .001), anger (Z = -2.214, p = .027), sleep (Z = -2.268, p = .023), help (Z = -2.184, p = .029), intrusiveness (Z = -2.469, p = .014), hyperarousal (Z = -2.717, p = .007), and total IES (Z = -2.456 , p =, 014). Mann Whitney test showed a significantly lower score on post-test Intrusiveness in the experimental group (U = 202, p = .038). Conclusions: The Expressive Writing intervention was effective in improving organizational and emotional variables. Expressive Writing supports healthcare professionals in relieving the burden of traumatic episodes, ordering associated thoughts and emotions, and implementing a process of deep comprehension.
2. Figley CR. Compassion fatigue as secondary traumatic stress disorder: An overview” In C. R. Figley (Ed.). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized 1995; 23, 1 - 20. Brunner Routledge, New York.
3. Kase S, Waldman E, Weintraub A. A Cross-Sectional Pilot Study of Compassion Fatigue (CF), Burnout (BO), and Compassion Satisfaction (CS) in Pediatric Palliative Care (PPC) Providers (S704). J Pain Symptom Manage 2018; 55(2),657 - 658.
4. Stamm BH. Professional quality of life: Compassion satisfaction and fatigue subscales, Version V (ProQOL). Center for Victims of Torture. Retrieved from https://proqol.org/ProQol_Test.html 2009
5. Slocum-Gori S, Hemsworth D, WY Chan W, Carson A, Kazanjian A. “Understanding Compassion Satisfaction, Compassion Fatigue And Burnout: A survey of the hospice palliative care workforce. Palliat Med 2011; 27(2), 172 - 178.
6. Bernard N. Resilience and professional joy: a toolkit for nurse leaders. Nurse Lead 2019; 17(1), 43 - 48.
7. Back AL, Steinhauser KE, Kamal AH, Jackson VA. Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors. J Pain Symptom Manage 2016; 52(2), 284 - 291.
8. Sanso N, Galiana L, Oliver A, Pascual A, Sinclair S, Benito E. Palliative Care Professionals’ Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death. J Pain Symptom Manage 2015; 50, 200 - 206.
9. Pennebaker JW, Beall SK. Confronting a traumatic event: Toward an understanding of inhibition and disease. J Abnorm Psychol 1986, 95(3), 274 - 281.
10. Pennebaker JW, Kiecolt-Glaser J, Glaser R. Disclosure of traumas and immune function: health implications for psychotherapy. J Consult Clin Psychol 1988; 56(2), 239 - 245.
11. Frattaroli J. Experimental disclosure and its moderators: a meta-analysis”. Psychol Bull 2006; 132(6), 823 - 865.
12. Van Emmerik AAP, Kamphuis JH, Emmelkamp PMG. Treating acute stress disorder and posttraumatic stress disorder with cognitive behavioral therapy or structured writing therapy: a randomized controlled trial. Psychother Psychosom 2008; 77(2), 93 - 100.
13. East P., Startup H., Roberts C., Schmidt U. Expressive Writing and Eating Disorder Features: a preliminary trial in a student sample of the impact of three writing tasks on eating disorder symptoms and associated cognitive, affective and interpersonal factors. Eur Eat Disord Rev 2010, 18(3), 180 - 196.
14. Hoyt T, Yeater E. The effects of negative emotion and expressive writing on post traumatic stress symptoms. J Soc Clin Psychol 2011, 30(6), 549 - 569.
15. Sadovnik A, Sumner K, Bragger J, Pastor SC. Effects of expressive writing about workplace on satisfaction, stress and well-being”. Journal of Academy of Business and Economics 2011, 11(4), 231 - 237.
16. Gallo I, Garrino L, Di Monte V.L’uso della scrittura espressiva nei percorsi di cura dei pazienti oncologici per la riduzione del distress emozionale: analisi della letteratura. [Using Expressive Writing in the care pathways for oncological patients to reduce emotional distress: literature analysis]. Prof Inferm 2015, 68(1), 29 - 36.
17. Metaweh M, Ironson G, Barroso J. The Daily Lives of People with HIV Infection: A Qualitative Study of the Control Group in an Expressive Writing Intervention. J Assoc Nurses AIDS Care 2016; 27(5), 608 - 622.
18. Tonarelli A, Cosentino C, Artioli D, Borciani S, Camurri E, Colombo B, D’Errico A, Lelli L, Lodini L, Artioli G. Expressive writing. A tool to help workers. Research project on the benefits of expressive writing. Acta Biomed 2017; 88(5), 13 - 21.
19. Greenbaum C.A, Javdani S. Expressive writing intervention promotes resilience among juvenile justice-involved youth. Child Youth Serv Rev 2017; 73, 220 - 229.
20. Glass O, Dreusicke M, Evans J, Bechard E, Wolever RQ. Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complement Ther Clin Pract 2019; 34, 240 - 246.
21. Mosher CE, DuHamel KN, Lam J, Dickler M, Li Y, Massie MJ, Norton L. (2012). Randomized trial of expressive writing for distressed metastatic breast cancer patients. Official Journal of the European Health Psychology Society 2012; 27, 88 - 100.
22. Kaur A, Sharma MP, Chaturvedi SK. Professional Quality of Life among Professional Care Providers at Cancer Palliative Care Centers in Bengaluru, India”. Indian J Palliat Care 2018; 24(2), 167 - 172.
23. Pierro A, Lombardo I, Fabbri S, Di Spirito A. Evidenza Empirica della Validità Discriminante delle Misure di Job Involvement e Organizational Commitment: Modelli di Analisi Fattoriale e Confermativa (via LISREL). [empirical evidence of the discriminant validity of Job Involvement and Organizational Commitment: Factorial and confirmative analysis models (via LISREL)]. TPM Test Psychom Methodol Appl Psychol 1995; 2, 1.
24. Allen NJ, Meyer JP. The measurement and antecedents of affective, continuance and normative commitment to the organization. J Occup Health Psychol 1990; 63, 1 - 18.
25. Capanna C, Stratta P, Hjemdal O, Collazzoni A, Rossi A. The Italian validation study of the resilience scale for adults (RSA). BPA-Applied Psychology Bulletin 2015; 63(272).
26. Friborg O, Hjemdal O, Rosenving, JH, Martinussen, M. A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment?. Int J Methods Psychiatr Res 2003; 12(2), 65-76.
27. Pollice R, Bianchini V, Roncone R, Casacchia M. Distress psicologico e disturbo post-traumatico da stress (DPTS) in una popolazione di giovani sopravvissuti al terremoto dell’Aquila [Psychological distress and Post Traumatic Stress Disorder (PTSD) in a population of young survivors to L’Aquila earthquake]. Riv Psichiatr 2012; vol. 47(1), pp. 59- 64.
28. Weiss DS. The Impact of Event Scale: Revised. In: Wilson J.P., Tang C.S. (eds) Cross-Cultural Assessment of Psychological Trauma and PTSD. International and Cultural Psychology Series. Springer 2007; Boston, MA. https://doi.org/10.1007/978-0-387-70990-1_10
29. Mitchell AJ. Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorder. J Clin Oncol 2007; 25 (29), 4670-4681.
30. Van Middendorp H, Sorbi MJ, Van Doornen LJP, Bijlsma JWJ, Geenen R. Feasibility and induced cognitive-emotional change of an emotional disclosure intervention adapted for home application”. Patient Educ Couns 2007; 66(2), 177 - 87.
31. Starnes BJ, Truhon SA. A primer on Organizational Commitment. Journal of Quality Technology 20096; 1 - 24.
32. Khaleh LABC., Naji S. The relationship between organizational commitment components and organizational citizenship behavior in nursing staff”. International Journal of medical Research & Health Science 2016; 5, 173 - 179.
33. Pennebaker JW, Chung CK. “Expressive writing: connection to physical and mental health”. The Oxford handbook of health psychology 2011, Cap.18, pp.417.
34. Lo Iacono G. (2016). Lo studio sperimentale della scrittura autobiografica: la prospettiva di James Pennebaker [The experimental study of autobiographical writing: James Pennebaker’s perspective]. Rivista di Psicologia dell’Emergenza e dell’Assistenza Umanitaria [Journal of Emergency Psychology and Humanitarian Care] 2016; 16, 34 - 60.
35. Tonarelli A, Cosentino C, Tomasoni C, Nelli L, Damiani I, Goisis S, Sarli L, Artioli G. Expressive writing. A tool to help health workers of palliative care. Acta Biomed 2018; 89(6),.35 - 42.
36. Nehmeh R. What is Organizational commitment, why should managers want it in their workforce and is there any cost effective way to secure it?”. SMC working paper 2009; Retrieved from: http://www.swissmc.at/Media/Ranya_Nehmeh_working_paper_05-2009.pdf
37. Lin C, Liang H, Han C, Hsieh C. Professional resilience among nursing working in an overcrowded emergency department in Taiwan”. Int Emerg Nurs 2019; 42, 44 - 50.
38. Lombardo B, Eyre C. Compassion fatigue: a nurses’ primer. Online J Issues Nurs 2011; 16(1).
39. Sanchez-Reilly S, Morrison LJ, Carey E, Bernacki R, O'Neill L, Kapo J, Periyakoil VS, deLima Thomas J. Caring for oneself to care for others: physicians and their selfcare. J Support Oncol 2013; 11(2), 75 - 81.
40. Wright J. Online counselling: Learning from writing therapy”. Br J Guid Counc 2002; 30(3), 285 - 298.
41. Smorti A. Narrazioni: cultura, memorie e formazione del sé [Narratives: culture, memories and self creation]. Giunti 2007, Firenze.
42. Cole M. Cultural psychology: A once and future discipline. Harvard University Press 1996, Cambridge.
43. Seagal JD, Pennebaker JW. Expressive writing and social stigma: benefit from writing about being a group member”. Unpublished Manuscript 1997; University of Texas, Austin.