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BackgroundHealthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of this relationship. This meta-analysis examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and the quality (perceived quality, patient satisfaction) and safety of healthcare.MethodsPublications were identified through targeted literature searches in Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, and ProQuest Dissertations & Theses through March of 2015. Two coders extracted data to calculate effect sizes and potential moderators. We calculated Pearson’s r for all independent relationships between burnout and quality measures, using a random effects model. Data were assessed for potential impact of study rigor, outliers, and publication bias.ResultsEighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = −0.26, 95 % CI [−0.29, −0.23]) and safety (r = −0.23, 95 % CI [−0.28, −0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients. Moderators for the quality relationship included dimension of burnout, unit of analysis, and quality data source. Moderators for the relationship between burnout and safety were safety indicator type, population, and country. Rigor of the study was not a significant moderator.DiscussionThis is the first study to systematically, quantitatively analyze the links between healthcare provider burnout and healthcare quality and safety across disciplines. Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators, and perceptions of safety. Though the effects are small to medium, the findings highlight the importance of effective burnout interventions for healthcare providers. Moderator analyses suggest contextual factors to consider for future study.

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.

The cognitive model of poor functioning in schizophrenia posits that defeatist performance beliefs—overgeneralized negative beliefs about one's ability to perform tasks—develop prior to the onset of psychosis and contribute to the development and maintenance of negative symptoms and poor functioning. Although several studies with schizophrenia samples have provided support for the model, there is a paucity of research investigating these beliefs in individuals with schizotypy—those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had two aims: to examine whether defeatist performance beliefs (1) are elevated in schizotypy compared to controls and (2) are associated with decreased quality of life and working memory and increased negative but not positive schizotypy traits in the schizotypy group. Schizotypy (n=48) and control (n=53) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Analyses revealed that the schizotypy group reported significantly more defeatist performance beliefs than the control group. Within the schizotypy group, increased defeatist performance beliefs were significantly associated with greater negative schizotypy traits and lower quality of life. No significant associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Results generally support the theoretical validity of the cognitive model of poor functioning in schizophrenia and suggest that elevated defeatist performance beliefs may contribute to the manifestation of subclinical negative symptom traits and reduced quality of life among those with a latent vulnerability for schizophrenia.

Stigma resistance, one's ability to block the internalization of stigma, appears to be a key domain of recovery. However, the conditions in which one is most likely to resist stigma have not been identified, and models of stigma resistance have yet to incorporate one's ability to consider the mind of others. The present study investigated the impact of the interaction between metacognition, or one's ability to form an integrated representation of oneself, others, and the world, and fear of negative evaluation on one's ability to resist stigma. Narratives of encounters with stigma shared by 41 persons with schizophrenia or schizoaffective disorders were first coded for spontaneous expressions of fear of negative evaluation from others. Two-step cluster analyses were then conducted in order to test the hypothesis that metacognition and fearing negative evaluation from others are important, interacting pathways which contribute to resisting stigma. Those with high (n = 11; 26.8%), intermediate (n = 9; 22.0%), and low metacognition (n = 21; 51.2%) significantly differed on stigma resistance (F = 9.49, p<0.001) and the high metacognition group was most likely to resist stigma. Those with high and low metacognition did not express fear of negative evaluation, while those with intermediate metacognition did express fear of negative evaluation.

In a phenomenological, qualitative research study, we administered in-depth interviews to 30 men who were deeply involved with female-abuse prevention programs in their respective communities. The participants were selected from delegates to a national abuse prevention conference. Three key, intrinsic values are reported which motivate their participation in female abuse prevention. First, men in our sample described the importance of constructs such as equality and safety, indicating that their efforts towards abuse prevention also were efforts towards social justice and gender equality. Second, as participants shared their beliefs regarding these abuse-related issues, the lenses through which these individuals viewed various situations and conditions seemed to match a feminist worldview. In turn, such perspectives motivated their involvement and desire to protect and empower women. Finally, men in our sample portrayed their belief that \"making a difference\" was possible. These individuals not only desired to better the men and women with whom they worked, but they also viewed their involvement as a necessary step toward the betterment of society. Overall, participants generally held shared perspectives regarding such abuse-related issues and these intrinsic values served as salient motivation for their own involvement.

The present phenomenological, qualitative research study involved in-depth interviews of all 16 female, sophomore students involved in respective distance relationships at a private, selective, comprehensive, Midwest university. Among other results found in the study, the present article focuses on communication dynamics involved with the relationships. Results showed key communication constructs to involve learning to communicate in a distance milieu, interpreting the tone of their boyfriends voice, compensating for their lack of contexts, working harder at communication, and committing themselves to the extra efforts involved with good communication. Generally, the women were content with their relationships. We interpret the findings to infer that it likely takes special individuals to make the communication in distance relationships work effectively. Further, we conclude that potential distance relationship couples should discuss the dynamics involved in the present findings prior to initiating distance relationships in order to best enhance the chances for distance relationship success.

Using qualitative research methods interviews were conducted with college students regarding the sources they used in generating perceptions of professional counselors. Respondents believed that word of mouth, media sources, and personal experiences were responsible for their understandings of professional counselors. The findings have applications for leaders in professional counseling organizations. [PUBLICATION ABSTRACT]

The present study summarizes previous qualitative research by Firmin, Hoffman, Firmin, Lee, & Vorobyov (2012) and Firmin, Hoffman, Firmin, Lee, & Vorobyov (2013) in which we had interviewed 24 college females who were 5'11\" or taller regarding their self-perceptions of being tall. The findings of these interviews are compared to findings from a present data collection of 23 college females who were 5'10\" or taller-but who had the added dynamic of being varsity college athletes. Women from both data sets shared overlapping perspectives regarding the extra attention they received, personal adjustments they had to make, social factors which impacted their lives, and difficulties they experienced with clothing, all as a result of their tallness. However, the two groups also differed in some key ways, with the athletic tall women reporting better satisfactions in some domains and yet greater frustrations in others. Particularly, this study lends to the idea that the tall athletes were better able to celebrate their tallness as a direct result of their participation and success in athletics. Conversely, participants in the athlete sample also shared an increased frustration which differed from their non-athlete counterparts. This frustration related to the possible perception of others that due to their height and body type they lacked desired femininity.

STUDY 1: Objective: Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Methods: Twenty-four individuals with SMI who were either peer-service-providers (those with lived experience providing services; n = 14) or consumers of mental health services (n = 10) engaged in semi-structured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Results: Stigma resistance is an ongoing, active process that involves using one’s experiences, knowledge, and sets of skills at the 1) personal, 2) peer, and 3) public levels. Stigma resistance at the personal level involves a) not believing stigma or catching and challenging stigmatizing thoughts, b) empowering oneself by learning about mental health and recovery, c) maintaining one’s recovery and proving stigma wrong, and d) developing a meaningful identity beyond mental illness. Stigma resistance at the peer level involves using one’s experiences to help others fight stigma and at the public level, resistance involved a) education, b) challenging stigma, c) disclosing one’s lived experience, and d) advocacy work. Discussion: Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services. STUDY 2: Background: Despite strong links between stigma resistance and recovery outcomes, limitations of existing measures of stigma resistance have contributed to this construct remaining largely under-studied. This study sought to develop and validate an improved measure of mental illness stigma resistance, grounded in the perspectives of people with lived experience. Method: An item pool was developed from qualitative interviews (Study 1) and items were piloted in an online MTurk sample with people self-reporting a mental illness diagnosis (n=489). Best performing items were selected and preliminary factor structure was examined using exploratory factor analysis in a subset of the sample (30%, n=161). The new measure was then administered to individuals at two state mental health consumer recovery conferences (n=202) and confirmatory factor analyses were conducted to assess factor structure and refine the measure. Validity of the new scale was then examined through correlations with theoretically relevant measures. Results: The EFA suggested possible models of either 1, 3, or 5 factors. CFA demonstrated that the 5-factor model best fit the remaining MTurk data (n=328) and this was replicated in the conference sample; these samples were then combined to refine the measure across a heterogeneous sample (n=530). The final 20-item measure demonstrated good internal consistency for the total score (.93) and each of the 5 subscales (.71 - .88), good test-retest reliability (.74), and strong construct validity. Discussion: This study produced an improved measure of stigma resistance with strong psychometric properties and construct validity. Use of this new measure will allow for a more nuanced assessment of stigma resistance across important domains of recovery.

Using qualitative research methodology, we interviewed 23 American students participating in a study abroad program at Oxford University in the U.K. Results showed four primary draws to participating in the study abroad program and two perceived drawbacks. Positively, Oxford's first appealing dynamic related to the tutorial system and students' expanded range of options for specialized topics as well as in-depth study. Next, participants highly valued Oxford's academic rigor, which accompanied the university's unique approach to education. Third, Oxford's location in England appealed to our participants. Finally, students reported hopes that future benefits would result from their decisions to attend Oxford and perceived associations with Oxford's prestige. As participants weighed these benefits of studying at OU, they contrasted the positive dynamics with two major drawbacks: finances and missed U.S. experiences. Nevertheless, our participants unanimously affirmed their respective decisions to study at Oxford and highly recommended the experience to future potential applicants.