The International Journal of Whole Person Care
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Perspectives of Ontarians with Multiple Sclerosis on Accessing Healthcare Services for Managing their Condition
Get PDFMultiple sclerosis (MS) requires complex care throughout life. Current Canadian literature demonstrates that persons with MS are high users of healthcare services, yet still have multiple unmet health care needs and low satisfaction with healthcare services received. This study investigated access to healthcare from the perspective of Ontarians with MS, using interpretive description methodology. Participants were 48 Persons with MS living across seven communities in Ontario recruited primarily through the MS Society of Canada. Data collection involved five focus groups plus ten individual semi-structured telephone interviews. Participants described access to healthcare services as a process of cost-benefit analysis that involved weighing out the likelihood of getting useful assistance against the range of expected barriers. Expected barriers were based on past experience and included a lack of patient-centered care, limited MS-related knowledge of generalists, and lack of affordability of preferred source of care. Ongoing experiences with these barriers led participants to believe that seeking care was not worth it. The result was that participants tended to avoid seeking healthcare services until they felt threatened by their health state, which then led to use of emergency services. Many participants also described completely disengaging from traditional healthcare services in favour of alternative treatments. Ontarians with MS report negative experiences with traditional healthcare services that fail to meet their complex care needs. Findings suggest that a patient-centered approach could reduce healthcare avoidance which may, in turn, reduce secondary complications and avoidable hospitalizations. (MS) requires complex care throughout life. Current Canadian literature demonstrates that persons with MS are high users of healthcare services, yet still have multiple unmet health care needs and low satisfaction with healthcare services received. This study investigated access to healthcare from the perspective of Ontarians with MS, using interpretive description methodology. Participants were 48 Persons with MS living across seven communities in Ontario recruited primarily through the MS Society of Canada. Data collection involved five focus groups plus ten individual semi-structured telephone interviews. Participants described access to healthcare services as a process of cost-benefit analysis that involved weighing out the likelihood of getting useful assistance against the range of expected barriers. Expected barriers were based on past experience and included a lack of patient-centered care, limited MS-related knowledge of generalists, and lack of affordability of preferred source of care. Ongoing experiences with these barriers led participants to believe that seeking care was not worth it. The result was that participants tended to avoid seeking healthcare services until they felt threatened by their health state, which then led to use of emergency services. Many participants also described completely disengaging from traditional healthcare services in favour of alternative treatments. Ontarians with MS report negative experiences with traditional healthcare services that fail to meet their complex care needs. Findings suggest that a patient-centered approach could reduce healthcare avoidance which may, in turn, reduce secondary complications and avoidable hospitalizations
Mindfulness-based self-care education for healthcare professional students in Japan
Get PDF[Background] Recent studies have consistently shown that medical students experience a high rate of psychological symptoms. In this situation, teaching mindfulness in medical school has the potential to prevent student burnout. However, there are few consistent educational programs in medical schools throughout Japan.[Method] Since 2015, Showa University (Tokyo) has practiced an intensive self-care program based on mindfulness for 600 first-year healthcare professional students in the schools of medicine, dentistry, pharmacy, nursing, and rehabilitation. The target objectives of this program were as follows: understand the needs of self-care, enhance self-awareness, evaluate evidence of mindfulness for mental diseases, and practice formal/informal mindfulness-based activities. This program consisted of a 90-minute lecture, followed by consecutive reflective activities, including completing personal journals and portfolios. The students were required to plan how to make use of what they learned in this course. The students were asked to complete a questionnaire upon completion of the course.[Results] The questionnaire indicated that more than 90% of the students were satisfied with the program, and about 25% started regular mindfulness-based practices such as meditation and breathing methods aimed to reduce test anxiety. Descriptions from the e-portfolio showed that the participants understood evitable stressors and the importance of the body-mind relationship.[Conclusion] Mindfulness-based self-care education can encourage healthcare students to understand the necessity of self-care during the early stages of their professional training. This program for the first year students will be followed by a course on Professionalism for healthcare professional students during their subsequent years of university education.
Graphic Medicine as Physician Tool to Understand Their Patient’s Experience of a Medical Condition
Get PDFBackgroundEngaging patients in their healthcare, listening to their stories, and improving the quality of their experience also depends on physicians understanding their patient’s experiences of a medical condition.Physicians have little time to converse with patients about this in the visit. Graphic Medicine – Comics – pictures and words together in sequence to tell a story – is a way to gain insight into a patient’s experience of what it’s like. MethodsA small, mixed-method study to test the effect on physicians of reading a comic book, “My Degeneration: Parkinson’s Disease.” The 13 participants, including 11 physician-editors (representing 10 disciplines), answered a 7-question pre-survey before receiving and reading the book, and a 10-question post survey. Also, the 12 participants present at the recent Permanente Journal Editorial meeting commented on their experience of reading the book, its attributes, and their recommendations for the comic book as an educational tool for residents and patients. ResultsGreatest Improvements were: “know patients’ wants,” (54%), “know treatments” (37%), “know patients’ needs” (34%) and “know patients’ experience” (30%). 82% recommended the comic book for resident education, and 73% for patients. Comments included: “My patients say:‘Doc, you guys really need to understand what’s going on for me. It’s really hard for me.’” “The things that people do to deal with their condition are remarkable!” “For a patient to have a conversation with his disease, as in the book, is a wonderful idea. “Combining pictures with words has triple the educational value for millennial residents who demand high yield.”
A Taster Of An Award-Winning Conflict Resolution Training Program For Pediatric Health Professionals
Get PDFIn 2013, the Medical Mediation Foundation and the Evelina London Children’s Hospital initiated a project to explore the nature and impact of conflict across paediatrics. Interestingly, staff were initially reluctant to name disagreements as ‘conflict’, but widespread canvassing of experience yielded a working definition of conflict which has ‘the breakdown of trust and communication breakdown’ and "impact on the ability of staff to provide optimal care to the child" at its core. The project, based on published research with families and health professionals, provides training to staff in recognising and managing conflict and an independent mediation service available to families, patients and staff to help resolve conflict if it escalates. The Evelina Resolution Project has become a nationally recognised, award-winning training programme. Interactive, multi-disciplinary sessions (usually half days, 12-20 staff) are co-trained, combining the expertise of a senior consultant paediatrician and an experienced accredited mediator. Six month follow up of a cohort of 313 staff found that more than half had experienced a conflict with a parent or patient since doing the training and of these, 95% reported that the training had helped them to recognise the warning signs and 91% said it had helped de-escalate the conflict. Feedback from more than 1600 Evelina staff trained to date, provides consistently high ‘quality’ ratings (95% rated the training as excellent/very good), ‘relevance’ ratings (99% - very relevant/relevant) This workshop will offer a condensed version of the training and an opportunity for participants to practise and discuss the skills taught.
Beyond Resilience and Burnout: The Need for Organizational Change to Promote Humanistic Practice and Teaching in Healthcare
Get PDFRapid changes in healthcare organization and practice environments, increasingly driven by business models and commercial interests, are associated with widespread burnout and dissatisfaction among healthcare professionals and pose barriers to humanistic relationship-centered quality care. Studies show burnout and significant stress currently affect over half of US physicians and nurses. Clinicians’ ability to provide compassionate care is significantly challenged. Most solutions to date have included individual interventions designed to enhance well-being and promote resilience. We examined organizational factors that inhibit or promote humanistic practice by faculty physicians in today’s healthcare environment. In this qualitative study, physician faculty who completed a one-year faculty development program in humanism at eight US academic medical centers provided written answers to two open-ended questions: a) What institutional or specific organizational unit-related factors promote humanism for you and others? b) What institutional or specific organizational unit-related factors inhibit or pose barriers, to humanism for you and others? 74% (68/92) of the physicians participated. The constant comparative method was used to analyze responses. We found that organizational culture was the central theme. Motivators of humanism included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities promoting humanism, and practice structures that facilitate humanism. Factors that inhibited humanism included “top down” organizational culture, non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. Our findings suggest that organizational culture is, at a minimum, equally important as individual interventions. We describe features of organizational culture that reinforce humanistic practice and care in healthcare institutions and offer recommendations for organizational change that support the primacy of humanistic, compassionate, high quality patient care.
Queering Whole Person Care
Get PDFThis workshop is the product of a research study exploring the strategies that queer people develop to navigate hegemonic, heteropatriarchal health care systems, and ways that nurse education can incorporate a narrative-based, whole person care approach to understanding and supporting the needs of queer patients. This mixed-methods study included interviews with queer people, nurse educators and practicing nurses; textual analysis of queer health narratives; close reading of queer, feminist and cultural theory; and autoethnography.Some of the questions that we will explore are: How do queers use personal narratives to help navigate health care systems not designed to see/meet their needs? How do queers challenge dominant power structures in medicine? What does whole person care look like in a queer context? What would nurses like to see included in nursing education, and what do queers want health providers to know? What are the key pedagogical challenges in attempting such communication?The stories that queer people carry with them to medical encounters are a rich and underutilized resource for health care providers, and a tool for patients trying to manage serious or chronic illness. We will explore methods for including storytelling in nursing education as well as patient care, and participants will engage in a narrative medicine/autoethnographic exercise.We hope participants will leave our workshop with a better understanding of queer peoples' experiences of health care, and ways that queers and nurses can work together for better health outcomes.
Shame in medical education: A mindful approach
Get PDFShame is a ubiquitous and potentially damaging emotion with many nuances (embarrassment, humiliation, disgrace, remorse, ridicule etc.). It can be defined as “a state of experiencing oneself as devalued, diminished and an object of derision in the mind of another or others, which when internalized textures a sense of oneself”. Shame regulates social behaviour by penalizing deviations from the norm, and rewarding conformity. The influence of shame on physicians and medical learners is conspicuously absent from the literature on emotional challenges in medicine. The dearth of research on shame is not surprising given that “it is shameful and humiliating to admit that one has been shamed and humiliated.” (Lazare, 1987) Existing literature highlights the harmful effects of shame on both physicians and learners. Humiliation is detrimental to student well-being and can lead to feelings of self-doubt, alienation and inferiority, triggers of perfectionism and loss of empathy. Practicing physicians are prone to shame if their authority is undermined, and may exhibit dismissive, defensive, or aggressive behaviors in the face of criticism, patient conflict or disagreements with colleagues. This workshop will explore mechanisms and implications of shame in medicine and medical education. We will present results from interviews with Norwegian medical students, and use an empirically validated approach called Mindful Practice to investigate challenging themes facing health professionals. This approach utilizes critical awareness (investigating the sources of shame), shared dialogue (reflecting on the personal impact of such experiences) and elements of appreciative inquiry (identifying individual qualities that mitigate negative effects)
Teaching an intensive core course for medical students in the era of Covid-19: Mindful Medical Practice on Zoom
Get PDFBackground The COVID19 pandemic brought many challenges, including delivering interactive courses such as the Mindful Medical Practice (MMP) program to medical students. It also provided opportunities to trial online teaching of the program using technologies such as Zoom. Approach Medical educators from McGill University in Montreal and The Rural Clinical School of Western Australia in Busselton collaborated via Zoom to adapt the MMP program to an online format. This involved weekly meetings to adapt each class and debrief following its delivery. A number of adaptations were required which were implemented with ease while maintaining the program’s integrity. Evaluation The facilitator found the course relatively straightforward to teach with Zoom. In their essays at the end of the coursethe students reported that the MMP program was a valuable experience that they found to be “enjoyable”, “positive”, “interesting”, “beneficial” and “refreshing”. They reported that the online experience offered benefits over face-to-face delivery and was particularly helpful during the COVID19 pandemic. Reflection There were a number of potential limitations: this was a relatively small group of students; the students were already well acquainted with the facilitator; the students and the facilitator were experienced in using Zoom for teaching. The major strength was a clear demonstration of the feasibility of delivering the entire program online that is particularly relevant during this time of stress and uncertainty and also expands the potential to provide this teaching to students and universities across the world
Music, Brain and Health
Get PDFMusic, like language, is a uniquely human experience, ubiquitous across human cultures and across the human life span.Musical capacity appears early in evolution and it seems to be innate to most of the human population. Neurobiological studies of music perception and music performance profoundly affect the brain, in an acute and chronic way, by modulating networks involved in cognition, sensation, emotion, reward, and movement corresponding to the empirical findings why people listen to music: pleasure, self-awareness, social relatedness, and arousal and mood regulation.Most intriguing is “salutogenic” effect of musical activities, such as instrumental and choral “musicking” (particularly in non-professional musicians), both on the individual level and in populations. Musical training can promote the development of non-musical skills as diverse as language development, attention, visuospatial perception, and executive functions.Music is also a prophylactic resource, it improves the bonding of mother and child. There is a wide range of therapeutic domains and disorders where musical interventions improve the outcome. As an example, familiar music has an exceptional ability to elicit memories, movements, motivation and positive emotions from adults affected by dementia.Considering that one of the most important problems in biomedicine is “understanding what is to be human” then “music should be an essential part of this pursuit” – of an understanding of the whole person. Despite evidence of significant effects of music on health and well-being - music is not well present in current re-humanization of medicine