{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:54Z","timestamp":1792787814077,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Australian Government Research Training Program Scholarship","id":[{"id":"https:\/\/ror.org\/0314h5y94","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Health Information Management Association of Australia"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIM J"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Health Information Managers (HIMs) routinely work with patient records containing detailed accounts of illness, trauma and death. While the biopsychosocial-spiritual (BPSS) impacts of trauma exposure have been widely documented among clinicians, little is known about the wellbeing of non-patient-facing health professionals who are repeatedly exposed to sensitive patient information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To explore the BPSS impacts experienced by HIMs following exposure to information contained within patient records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A qualitative study informed by grounded theory methodology was undertaken. Semi-structured interviews were conducted with 30 HIMs employed across a range of Victorian healthcare organisations in Australia. Participants were purposively recruited to represent diverse career stages and workplace settings. Interview data were analysed using reflexive thematic analysis, guided by the BPSS framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All participants described impacts in at least one BPSS domain, with many reporting experiences across multiple domains. All participants experienced psychological impacts such as empathy, emotional distress, personal resonance, health anxiety, intrusive thoughts, emotional fatigue, desensitisation and positive psychological responses. Three-quarters of respondents experienced spiritual impacts such as existential reflection, moral and ethical appraisal, compassion, helplessness and gratitude. Biological impacts affected over 50% of participants and included somatic (physical) expressions of emotion, sleep disturbances and physical fatigue. Social impacts were least prevalent, affecting only 10% of participants, and included health advocacy within personal networks and social withdrawal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Findings demonstrated that repeated exposure to patient information alone, despite the absence of direct patient contact, was sufficient to influence participants\u2019 wellbeing across multiple domains. These findings challenge assumptions that non-patient-facing health professionals, including HIMs, are unaffected by the emotional consequences of patient care and highlight the importance of recognising occupational wellbeing risks associated with indirect exposure to trauma-related material.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for health information management practice:<\/jats:title>\n                    <jats:p>Recognition of BPSS impacts should inform workplace wellbeing initiatives and professional support for the HIM workforce. The findings also highlight the need to consider how education and ongoing professional development can better prepare HIMs to recognise and manage the potential wellbeing impacts associated with working with sensitive patient information.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18333583261489939","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:01:11Z","timestamp":1791795671000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The biopsychosocial-spiritual impact upon health information managers from exposure to sensitive information within patient records: A qualitative study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2634-8892","authenticated-orcid":false,"given":"Melanie","family":"Tassos","sequence":"first","affiliation":[{"name":"La Trobe University, Bundoora, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1120-7798","authenticated-orcid":false,"given":"Lindsay B.","family":"Carey","sequence":"additional","affiliation":[{"name":"La Trobe University, Bundoora, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1350-1416","authenticated-orcid":false,"given":"Stephanie","family":"Gjorgioski","sequence":"additional","affiliation":[{"name":"La Trobe University, Bundoora, VIC, Australia"},{"name":"Canberra Health Service, Garran, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Hodge","sequence":"additional","affiliation":[{"name":"La Trobe University, Bundoora, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4230-7062","authenticated-orcid":false,"given":"Merilyn","family":"Riley","sequence":"additional","affiliation":[{"name":"La Trobe University, Bundoora, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_2_2_1","volume-title":"Moral, Religious, or Spiritual Problem. Code: Z65-8. DSM-5-TR\u00ae Update Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision September 2025","author":"APA-DSM-5","year":"2025","unstructured":"APA-DSM-5 (2025) Moral, Religious, or Spiritual Problem. Code: Z65-8. DSM-5-TR\u00ae Update Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision September 2025. American Psychiatric Association."},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Bailey DP (2021) Sedentary behaviour in the workplace: Prevalence health implications and interventions. British Medical Bulletin 137(1): 42\u201350. https:\/\/doi.org\/10.1093\/bmb\/ldaa039","DOI":"10.1093\/bmb\/ldaa039"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Beck CT (2011) Secondary traumatic stress in nurses: A systematic review. Archives of Psychiatric Nursing 25(1): 1\u201310. https:\/\/doi.org\/10.1016\/j.apnu.2010.05.005","DOI":"10.1016\/j.apnu.2010.05.005"},{"key":"e_1_3_2_5_1","doi-asserted-by":"crossref","unstructured":"Braun V Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_3_2_6_1","first-page":"198","volume-title":"Speech-Language Pathology and Palliative Care","author":"Carey LB","year":"2026","unstructured":"Carey LB, Mathisen BA, Carey CL, et al. (2026) Speech-language pathology, spirituality and palliative care. In: Chahda L, Mathisen B, Carey LB (eds) Speech-Language Pathology and Palliative Care. Taylor & Francis, p.198."},{"key":"e_1_3_2_7_1","doi-asserted-by":"crossref","unstructured":"Carey LB Hodgson TJ (2018) Chaplaincy spiritual care and moral injury: Considerations regarding screening and treatment. Frontiers in Psychiatry 9(619): 1\u201310. https:\/\/doi.org\/10.3389\/fpsyt.2018.00619","DOI":"10.3389\/fpsyt.2018.00619"},{"key":"e_1_3_2_8_1","doi-asserted-by":"crossref","unstructured":"\u010cartolovni A Stolt M Scott PA et al. (2021) Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics 28(5): 590\u2013602. https:\/\/doi.org\/10.1177\/0969733020966776","DOI":"10.1177\/0969733020966776"},{"key":"e_1_3_2_9_1","first-page":"198","volume-title":"Speech-Language Pathology and Palliative Care","author":"Chahda L","year":"2026","unstructured":"Chahda L, Mathisen B, Carey LB (eds) (2026) Speech-Language Pathology and Palliative Care. Taylor & Francis, p.198."},{"key":"e_1_3_2_10_1","doi-asserted-by":"crossref","unstructured":"Dickson-Swift V (2022) Undertaking qualitative research on trauma: Impacts on researchers and guidelines for risk management. Qualitative Research in Organizations and Management 17(4): 469\u2013486. https:\/\/doi.org\/10.1108\/QROM-11-2021-2248","DOI":"10.1108\/QROM-11-2021-2248"},{"key":"e_1_3_2_11_1","doi-asserted-by":"crossref","unstructured":"Dong H Falis M Whiteley W et al. (2022) Automated clinical coding: What why and where we are? NPJ Digital Medicine 5(1): 159. https:\/\/doi.org\/10.1038\/s41746-022-00705-7","DOI":"10.1038\/s41746-022-00705-7"},{"key":"e_1_3_2_12_1","doi-asserted-by":"crossref","unstructured":"Draucker CB Martsolf DS Poole C (2009) Developing distress protocols for research on sensitive topics. Archives of Psychiatric Nursing 23(5): 343\u2013350.","DOI":"10.1016\/j.apnu.2008.10.008"},{"key":"e_1_3_2_13_1","doi-asserted-by":"crossref","unstructured":"Engel GL (1977) The need for a new medical model: A challenge for biomedicine. Science 196(4286): 129\u2013136. https:\/\/doi.org\/10.1126\/science.847460","DOI":"10.1126\/science.847460"},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Etherington K (2007) Working with traumatic stories: From transcriber to witness. International Journal of Social Research Methodology 10(2): 85\u201397. https:\/\/doi.org\/10.1080\/13645570701334001","DOI":"10.1080\/13645570701334001"},{"key":"e_1_3_2_15_1","doi-asserted-by":"crossref","unstructured":"Fincham B Scourfield J Langer S (2008) The impact of working with disturbing secondary data: Reading suicide files in a coroner\u2019s office. Qualitative Health Research 18(6): 853\u2013862. https:\/\/doi.org\/10.1177\/1049732307308945","DOI":"10.1177\/1049732307308945"},{"key":"e_1_3_2_16_1","doi-asserted-by":"crossref","unstructured":"Granek L Krzyzanowska MK Nakash O et al. (2016) Gender differences in the effect of grief reactions and burnout on emotional distress among clinical oncologists. Cancer 122(23): 3705\u20133714. https:\/\/doi.org\/10.1002\/cncr.30236","DOI":"10.1002\/cncr.30236"},{"key":"e_1_3_2_17_1","doi-asserted-by":"crossref","unstructured":"Hanna E (2019) The emotional labour of researching sensitive topics online: Considerations and implications. Qualitative Research 19(5): 524\u2013539. https:\/\/doi.org\/10.1177\/1468794118781735","DOI":"10.1177\/1468794118781735"},{"key":"e_1_3_2_18_1","unstructured":"Health Information Management Association of Australia (HIMAA) (2023) Health Information Manager (HIM) Professional Competency Standards (Entry-Level) Version 4.0. HIMAA. Available at: https:\/\/www.himaa.org.au\/public\/169\/files\/Website%20Document\/Our%20Work\/Competency%20Standards\/HIM%20Professional%20Competency%20Standards%20v_4%202023.pdf (accessed 20 May 2026)."},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Jackson S Backett-Milburn K Newall E (2013) Researching distressing topics: Emotional reflexivity and emotional labor in the secondary analysis of children and young people\u2019s narratives of abuse. Sage Open 3(2): 1\u201312. https:\/\/doi.org\/10.1177\/2158244013490705","DOI":"10.1177\/2158244013490705"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780190088859.001.0001"},{"key":"e_1_3_2_21_1","doi-asserted-by":"crossref","unstructured":"LaDonna KA Watling CJ Cristancho SM et al. (2021) Exploring patients\u2019 and physicians\u2019 perspectives about competent health advocacy. Medical Education 55(4): 486\u2013495. https:\/\/doi.org\/10.1111\/medu.14408","DOI":"10.1111\/medu.14408"},{"key":"e_1_3_2_22_1","doi-asserted-by":"crossref","unstructured":"Lalor JG Begley CM Devane D (2006) Exploring painful experiences: Impact of emotional narratives on members of a qualitative research team. Journal of Advanced Nursing 56(6): 607\u2013616. https:\/\/doi.org\/10.1111\/j.1365-2648.2006.04039.x","DOI":"10.1111\/j.1365-2648.2006.04039.x"},{"key":"e_1_3_2_23_1","volume-title":"Doing Research on Sensitive Topics","author":"Lee RM","year":"1993","unstructured":"Lee RM (1993) Doing Research on Sensitive Topics. Sage."},{"key":"e_1_3_2_24_1","first-page":"351","volume-title":"Stress: Concepts, Cognition, Emotion, and Behavior","author":"Maslach C","year":"2016","unstructured":"Maslach C, Leiter MP (2016) Burnout. In: Fink G (ed.) Stress: Concepts, Cognition, Emotion, and Behavior. Academic Press, pp.351\u2013357."},{"key":"e_1_3_2_25_1","doi-asserted-by":"crossref","unstructured":"Mckenzie SK Li C Jenkin G et al. (2017) Ethical considerations in sensitive suicide research reliant on non-clinical researchers. Research Ethics 13(3\u20134): 173\u2013183. https:\/\/doi.org\/10.1177\/1747016116649996","DOI":"10.1177\/1747016116649996"},{"key":"e_1_3_2_26_1","doi-asserted-by":"crossref","unstructured":"Ogi\u0144ska-Bulik N Gurowie PJ Michalska P et al. (2021) Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study. PLoS One 16(2): e0247596. https:\/\/doi.org\/10.1371\/journal.pone.0247596","DOI":"10.1371\/journal.pone.0247596"},{"key":"e_1_3_2_27_1","doi-asserted-by":"crossref","unstructured":"Parker N O\u2019Reilly M (2013) \u201cWe are alone in the house\u201d: A case study addressing researcher safety and risk. Qualitative Research in Psychology 10(4): 341\u2013354. https:\/\/doi.org\/10.1080\/14780887.2011.647261","DOI":"10.1080\/14780887.2011.647261"},{"key":"e_1_3_2_28_1","doi-asserted-by":"crossref","unstructured":"Payne P Levine PA Crane-Godreau MA (2015) Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology 6: 124489. https:\/\/doi.org\/10.3389\/fpsyg.2015.00093","DOI":"10.3389\/fpsyg.2015.00093"},{"key":"e_1_3_2_29_1","doi-asserted-by":"crossref","unstructured":"Phelps AJ Adler AB Belanger SAH et al. (2024) Addressing moral injury in the military. BMJ Military Health 170(1): 51\u201355. https:\/\/doi.org\/10.1136\/bmjmilitary-2022-002128","DOI":"10.1136\/bmjmilitary-2022-002128"},{"key":"e_1_3_2_30_1","first-page":"11","volume-title":"Handbook of Positive Body Image and Embodiment: Constructs, Protective Factors, and Interventions","author":"Piran N","year":"2019","unstructured":"Piran N (2019) The experience of embodiment construct: Reflecting the quality of embodied lives. In: Tylka TL, Piran N (eds) Handbook of Positive Body Image and Embodiment: Constructs, Protective Factors, and Interventions. Oxford University Press, pp.11\u201321."},{"key":"e_1_3_2_31_1","doi-asserted-by":"crossref","unstructured":"Puchalski CM Vitillo R Hull SK et al. (2014) Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine 17(6): 642\u2013656. https:\/\/doi.org\/10.1089\/jpm.2014.9427","DOI":"10.1089\/jpm.2014.9427"},{"key":"e_1_3_2_32_1","doi-asserted-by":"crossref","unstructured":"Roche N Darzins S Oakman J et al. (2022) Worker experiences of the work health and safety impacts of exposure to dying and death in clinical settings: A qualitative scoping review. OMEGA \u2013 Journal of Death and Dying 90(3): 1193\u20131228. https:\/\/doi.org\/10.1177\/00302228221117902","DOI":"10.1177\/00302228221117902"},{"key":"e_1_3_2_33_1","doi-asserted-by":"crossref","unstructured":"Samson T Shvartzman P (2017) Association between level of exposure to death and dying and professional quality of life among palliative care workers. Palliative and Supportive Care 16(4): 442\u2013451. https:\/\/doi.org\/10.1017\/S1478951517000487","DOI":"10.1017\/S1478951517000487"},{"key":"e_1_3_2_34_1","doi-asserted-by":"crossref","unstructured":"Sorensen R Iedema R (2009) Emotional labour: Clinicians\u2019 attitudes to death and dying. Journal of Health Organization and Management 23(1): 5\u201322. https:\/\/doi.org\/10.1108\/14777260910942524","DOI":"10.1108\/14777260910942524"},{"key":"e_1_3_2_35_1","doi-asserted-by":"crossref","unstructured":"Sulmasy DP (2002) A biopsychosocial-spiritual model for the care of patients at the end of life. The Gerontologist 42(suppl_3): 24\u201333. https:\/\/doi.org\/10.1093\/geront\/42.suppl_3.24","DOI":"10.1093\/geront\/42.suppl_3.24"},{"key":"e_1_3_2_36_1","doi-asserted-by":"crossref","unstructured":"Tassos M Carey LB Gjorgioski S et al. (2025) The biopsychosocial\u2013spiritual impact on non-clinical health professionals who interact with traumatic and\/or sensitive health data: A scoping review. Health Information Management Journal 55(3): 385\u2013397. https:\/\/doi.org\/10.1177\/18333583251338406","DOI":"10.1177\/18333583251338406"},{"key":"e_1_3_2_37_1","doi-asserted-by":"crossref","unstructured":"Vaartio H Leino-Kilpi H (2005) Nursing advocacy: A review of the empirical research 1990\u20132003. International Journal of Nursing Studies 42(6): 705\u2013714. https:\/\/doi.org\/10.1016\/j.ijnurstu.2004.10.005","DOI":"10.1016\/j.ijnurstu.2004.10.005"},{"key":"e_1_3_2_38_1","doi-asserted-by":"crossref","unstructured":"West CP Dyrbye LN Shanafelt TD (2018) Physician burnout: Contributors consequences and solutions. Journal of Internal Medicine 283(6): 516\u2013529. https:\/\/doi.org\/10.1111\/joim.12752","DOI":"10.1111\/joim.12752"},{"key":"e_1_3_2_39_1","doi-asserted-by":"crossref","unstructured":"Wilkes L Cummings J Haigh C (2015) Transcriptionist saturation: Knowing too much about sensitive health and social data. Journal of Advanced Nursing 71(2): 295\u2013303. https:\/\/doi.org\/10.1111\/jan.12510","DOI":"10.1111\/jan.12510"},{"key":"e_1_3_2_40_1","unstructured":"Yaribeygi H Panahi Y Sahraei H et al. (2017) The impact of stress on body function: A review. EXCLI Journal 16: 1057\u20131072. https:\/\/doi.org\/10.17179\/excli2017-480"},{"key":"e_1_3_2_41_1","doi-asserted-by":"crossref","unstructured":"Zheng R Lee SF Bloomer MJ (2017) How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal of Clinical Nursing 27(1\u20132): e39\u2013e49. https:\/\/doi.org\/10.1111\/jocn.13975","DOI":"10.1111\/jocn.13975"}],"container-title":["Health Information Management Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18333583261489939","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/18333583261489939","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/18333583261489939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:17:51Z","timestamp":1791911871000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/18333583261489939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":40,"alternative-id":["10.1177\/18333583261489939"],"URL":"https:\/\/doi.org\/10.1177\/18333583261489939","relation":{},"ISSN":["1833-3583","1833-3575"],"issn-type":[{"value":"1833-3583","type":"print"},{"value":"1833-3575","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"18333583261489939"}}