The International Journal of Whole Person Care
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Kintsugi mind: clinicians can emerge from the pandemic whole
Get PDFThe Japanese practice an ancient art called Kintsugi. A craftsperson repairs broken pottery with gold or silver rendering it more beautiful than in its original state. Can clinicians engage in “Kintsugi Mind” and thereby emerge from this pandemic integrated and whole?
Yuan et al. (2021) conducted a meta-analysis including 88 studies of post-traumatic stress disorder (PTSD) following earlier pandemics and COVID-19. Health care professionals had the highest prevalence (26.9%) compared to infected cases and the public. Another type of trauma is called secondary or vicarious; it occurs when a person bears witness to suffering and death but remains powerless to change it; countless clinicians have experienced this over the past year. It manifests as emotional depletion, anxiety, insomnia, and impaired interpersonal relationships.
How can clinicians heal from their exposure to the pandemic? Post-traumatic growth (PTG) is defined as positive psychological changes following trauma. PTG manifests in five areas: appreciation of life, relating to others, personal strength, recognizing new possibilities, and spiritual change. A transformation in the person’s world view and their place in it ensues. For health care professionals who are experiencing emotional distress, insomnia, or manifest PTSD symptoms they may heal by engaging in the six “Rs.” These are: relating, resourcing, repatterning, reprocessing, reflecting, and rituals. Both PTG and these six practices may contribute to Kintsugi Mind. While this appears to place the onus on individuals, it is crucial that leaders in the health care system implement programs enabling HCPs to be restored, rather than broken by this crisis.
 
Lessons from the "non-critical" patient during a pandemic: developmental-behavioural pediatric populations & COVID-19
Get PDFSeemingly overnight, in March 2020, the world was turned upside down by the global SARS-CoV 2 (novel coronavirus) pandemic. As COVID-19 affected all aspects of clinical care, Canadian ambulatory clinics for any service deemed "non-urgent" or "non-critical," were suspended for several months. When outpatient care slowly resumed during the summer and fall of 2020, the backlog of patients in these areas and subsequent requests for follow-up significantly outpaced the number of available appointments. In fact, it became apparent that certain patients' needs had grown in unprecedented ways during the pandemic, even though their issues had previously been given low priority during the acute crisis period. Among these groups were youth with underlying mental health conditions, those with chronic but non-life-threatening illnesses, and the subgroups seen in Developmental-Behavioural Pediatrics. In Montréal, they were among the least likely to have their needs met as the waves of COVID-19 moved through the community, and many still struggle to find relevancy in the discussions about the hidden impacts of the coronavirus pandemic, even one year later.
What can the experiences of these marginalised youth teach us about what our system labels less relevant care in the context of an acute health care crisis? A short narrative presentation will demonstrate insights gleaned from 2020 & early 2021 to underscore the often unrecognised challenges faced by these populations and their families
Traditional & narrative practices of treatment for depression and depressive symptoms in older adults
Get PDFAn analysis and evaluation of the literature regarding traditional treatment methods for depression among older adults compared the effectiveness of the results to the benefits of a treatment plan that integrates the narrative practices of storytelling and reflexive writing. Priority was given to peer-reviewed journal articles from 2008 forward, though some earlier information was used for clarification and foundation building.
The formation and implementation of individual patient treatment plans for depression and depressive symptoms are impacted by many variables such as: Confusion surrounding provider treatment guidelines, social organizational context, organizational climate and the differing definitions of depression that exist among providers and patients. Patients often struggle to self-identify or put words to depressive symptoms and the process of reflexive writing is transformative and increases narrative competency, which strengthens a patient’s ability to give an account of oneself, aiding in self-discovery and personal symptom awareness.
An imbalance of power exists in the clinical encounter and the practices and principles of the discipline of Narrative Medicine can have a positive impact on strengthening the therapeutic alliance and treatment outcomes. Older adults with depression and depressive symptoms have a lower quality of life and often feel less productive in their communities. Traditional pharmacologically based depression treatment plans are one-dimensional and often fail to address personal patient context and preference. Older adults living with diagnosed depression and depressive symptoms can be better served with treatment plans that include narrative techniques that increase alliance, affiliation, self-awareness and self-discovery.
 
Adaptive challenges of curriculum implementation for enhancing medical student resilience at Showa University in Japan
Get PDFIt has been consistently reported that medical students experience a high rate of psychological morbidity, depersonalization, and low personal accomplishment around the world. Under the circumstances, resilience-enhancing programs have been gathering attention and partially implemented even in Japan. However, most of the programs just imitate resiliency programs in North America even though studies have indicated that there are cultural differences between East Asia and North America in the capacity to cope with a stressful situation.
The presenters investigated what factors might affect the similarities or differences in the perception of resilience among experienced palliative care physicians in Canada and Japan in 2017-2018. This study showed that Japanese physicians are more likely to rely on “Relationships” with other persons such as family members, friends, mentors or colleagues; in contrast, Canadian physicians tended to be more focused on individual factors such as “Autonomy” and “Confidence”.
As a result, the presenters at Showa University School of Medicine in Japan have implemented a progressively advancing resiliency program in a passed manner for the 1st through 6th year medical students as part of a new curriculum. This represents one of the most drastic revisions of curriculum in the school’s history. This presentation will introduce a course for resiliency programs as part of a new curriculum, including course description, course content, educational objectives, instructional strategies and the tips for the classroom teaching and learning.
 
The impact of virtual care on relationship centered care: Observations of a family physician
Get PDFThe COVID-19 pandemic propelled many physicians and their patients into an unfamiliar world of virtual care. This presentation is based on the perceptions of a family physician/ teacher/ researcher with 43 years of interest in, and promotion of, a strong doctor-patient relationship. It will describe a protocol that governed how tele-medicine and video-conferencing took place over nearly 18 months in his practice. It will then describe observed positive and negative impacts for the patients, their family members, the physician, and members of the family medicine health care team. Interpretation will be made about what such observations mean for the doctor-patient relationship.
 
Developing a collaborative, humanistic interprofessional healthcare culture: a multi-site study
Get PDFIntroduction:Developing a collaborative, humanistic interprofessional healthcare culture requires optimal relational skills, respect, interpersonal cohesion, and role clarity. We developed a longitudinal curriculum to engender these skills and values in institutional leaders. We report results of a qualitative study at seven US-based academic health centers to identify participants’ learning.
Methods:At each institution, participants from at least three different professions met in small group sessions twice-monthly over nine months. Sessions focused on relational capacities to enhance leadership and professionalism, and utilized critical reflection and experiential learning to promote teamwork, self-knowledge, communication skills, and address challenges encountered by a healthcare team. Participants completed reflective responses to open-ended questions asking what knowledge, insights, or skills they gained by working in this interprofessional group and applications of their learning. Five investigators analyzed the anonymized responses using the constant comparative method.
Results:Overarching themes centered on relationships and the strength of the relational nature of the learning. We observed learning on three levels:
a) Intrapersonal learning included self-awareness, mindfulness, and empathy for self that translated to reflections on application of these to teamwork and teaching;
b) Interpersonal learning concerned relational skills and teaching about listening, understanding others’ perspectives, appreciation/respect for colleagues, and empathy for others;
c) Systems level learning included teaching skills about resilience, conflict management, team dynamics and cultural norms, and appreciation of resources from interprofessional colleagues.
Discussion:A curriculum focusing on humanistic teaching for leaders led to new insights and positive changes in relational perspectives. Learning occurred on multiple levels. Many learners reported revising previous assumptions, a marker for transformative learning. Humanistic faculty development can facilitate deep bonds between professions.
 
Where there's smoke: digital storytelling for healing
Get PDFColumbia University School of the Arts’ Digital Storytelling Lab, in collaboration with Columbia’s Department of Narrative Medicine, developed Where There’s Smoke, a story and grief ritual that mixes interactive documentary, immersive theatre and online collaboration to invite healthcare providers and others into resonant conversations about life, loss and memory, and to imagine how stories can be used to create empathetic healing spaces.
When Robert Weiler was diagnosed with terminal colon cancer, the complexity of healthcare and ensuing grief for the family, led his son Lance, a storytelling pioneer, to realize that a straightforward story wasn’t enough to explain and explore the experience, so he created Where There’s Smoke.
Where There’s Smoke premiered in 2019 at the Tribeca Film Festival where it was hailed as an “absolute can’t miss” (Backstage). However, when COVID-19 submerged the world in loss, uncertainty, and isolation, Lance reimagined the piece as an online experience. He also combined the piece with protocols of Narrative Medicine as provided by faculty, Deborah Starr.
The piece traces a heartbreaking journey through end-of-life care and grief, embracing grief as nonlinear and immersive, grief as an escape room with no escape. Participants sift through artwork, videos, and conversations and are provided with immersive moments for individuals, pairs and groups to have opportunities for self-discovery, unexpected intimacy, and ensuing healing. This is a personal yet universally relevant narrative, which gradually reveals itself to be something more…the possibility of immersive storytelling to create space for empathetic healing, grieving, and connecting
