The International Journal of Whole Person Care
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Married just in time: Deathbed weddings, meaning and magic
Get PDFBackground :Brave conversations in hospital, often facilitated by the palliative care team, lead to a discovery of what really matters if time is short.Getting married turned out to be high on the agenda for many couples where one partner is facing mortality.There has been little exploration of romance and marriage in the context of advanced illness. Method:7 deathbed weddings in a tertiary cancer centre were analysed. These had taken place over a period of 2 years. Initial conversations, subsequent arrangements, the impact on the couple, and the subsequent reactions in bereavement were explored. Demographics, illness details, reasons for the marriage and logistics of the wedding were recorded Bereaved spouses were subsequently interviewed about the meaning of the wedding. Results:6/7 weddings were identified as ‘goals’ by the palliative care team On average the time from conversation to wedding was 10 days 3/7weddings took place within 1 day of the conversation Wedding outfits ranged from pyjamas to full white wedding on a hospital ward.5/7 brides/grooms died in hospital, on average 16 days after the wedding, In terms of meaning, this ranged from legal and financial reasons, to a statement of love and connection Discussion:Momentous celebrations distracted patients, relatives and healthcare team from the daily tragedy they were immersed in. The focus became one of healing not curing. Teams were uplifted, symptoms improved.The stories reinforced the idea that self-esteem and need for connection are dominant forces even in the face of death.
Teaching through Storytelling
Get PDFHave you ever felt envious of how a presenter told a story or engaged their audience? Even more personally, have you ever experienced how they captivated their audience while teaching the same material you teach. Did you feel like perhaps you were not so engaging with your audience or your audience wasn’t so engaged with you? Perhaps you are looking for a fresh way to present old themes and concepts. Through spending time in this workshop, you will come away with a practiced plan in hand for your next teaching endeavor. The purpose of this workshop is to empower you during the 90 minutes we have together to understand the mindset, skillset and toolset for storytelling. After we get to know each other, we’ll spend time with a brief few minutes didactic followed by time to write, craft and share that element of your story. Each person will then identify at least a single teaching topic for the focus of their story. That will be their focus for the workshop. This will process will repeat for each storytelling skill. There will be didactic, but the focus is on storytelling refinement so when you leave the workshop you have a plan specific to a topic you teach. The workshop concludes with participants voluntarily sharing their stories and reflecting on this process
Resilience in Adolescent Chronic Pain: An Exploration of Coping Mechanisms and Protective Psychological Factors
Get PDFIntroduction: Adolescents living with Chronic Pain (CP) are vulnerable to negative outcomes such as disability and impaired quality of life; they often miss schools, are unable to maintain social contacts, have sleep disturbances, and suffer from anxiety and depression. The continuation of avoidance coping behaviour beyond normal healing time had also been shown to result in negative consequences such as Disuse Syndrome—a state associated with physical deconditioning, sick role behaviour, psychosocial withdrawal, as well as negative and catastrophic beliefs.Objective: This study uses an interpretative phenomenological approach to explore individual positive thought processes, adaptation efforts, coping mechanisms, as well as resilience resources (beneficial social situations and solid family ties) that adolescents adopt to minimize the impact of pain and its consequences. The ultimate goal is to liaise with fellow physicians, allied researchers, and policy makers to modify, adapt, and improve current adolescent CP services. This way, we can help patients foster skills that will allow them to adapt positively, regain a balanced social life, and live successfully despite their pain.Results / Findings: Central to all accounts is a sense of interrupted life—phrases with negative connotations such as “couldn’t do” and “had to stop” are repeatedly used to express feelings of loss of control.To regain control over their situation, participants create within themselves a positive internal dialogue: they reconstruct the meaning of normalcy, practice acceptance, make downward social comparisons, and engage in daily positive affirmations. While chronic pain disrupts their career trajectories, the experience of living with pain has instilled in them the pursuit of significance. This pursuit is propelled by the imagery of a full life and seems to be particular to this age group. Ironically, some participants are seen to be grateful for their pain. Living with pain has gifted them with intuitive empathy for the suffering of others, as well as the emotional credibility to help
A Call for Compassion and Culture Change for Addicted Doctors
Get PDFThere is a code of silence regarding addicted doctors in medicine. While the doctor is minimizing or denying the problem, often her or his co-workers look the other way. Colleagues may be concerned but hold back from “denouncing” one of their own. Yet, ethical and legal issues are real. Patient care may be compromised. This presentation will engage listeners by asking several reflective questions. The 4 C’s of addiction will be reviewed. Signs of addiction will be enumerated. Why doctors become entangled in substances will be examined. Is addiction different from burnout? If so, how? The adverse consequences of addiction will be reviewed. How can compassion be offered for a problem that triggers blame and shame?Impaired doctors are usually referred to Physician Health Programs. What do they offer? Can the Buddhist view of addiction contribute to Western therapies? Addiction recovery will be examined through a mindfulness lens.This, however, still puts the onus on the individual who struggles with addiction. What about the medical culture may contribute to the problem? Can this be changed? If so, how? Addicted doctors are not alone, and the problem is more than personal. Rather than simply review the literature, this presentation will engage the audience so that the taboo of addiction can be tackled. It is intended to break the silence such that upon return to work, participants may notice a colleague who shows signs of addiction and then open their hearts to offer support
The Recovery Transition Program: An innovative recovery-oriented, peer-based mentoring program in addiction services
Get PDFThe Recovery Transition Program (RTP): Rationale, design, and delivery of an innovative recovery-oriented, peer-based mentoring program into addiction and mental health services The RTP is an award-winning complementary approach to standard care implemented by patients and staff in the Mental Health Mission at the McGill University Health Centre (MUHC). The RTP was designed to reduce relapses, improve recovery and patient experiences of care. In the RTP trained patient volunteers – called Peer Mentors – provide one-on-one peer mentoring, create workshops, facilitate group discussions, run family/caregiver meetings, and participate in creative activities. Collectively the RTP provides a supportive, learning and skill-building environment designed to help Peer Mentors, patients and families in their recovery. This workshop will outline the rationale/design of the program, its mission and mandate, as well as practical issues related to ethics, supervision of Peer Mentors, governance, financing, policies (e.g. code of conduct) and procedures (e.g. forms, referral methods). Discussion will include the design and delivery of the 30-hour Peer Mentor Training Program that covers topics related to roles, confidentiality, communication and listening skills, boundaries and self-disclosure, dealing with crisis, and self-care. Results of the formal RTP program evaluation will be presented. This includes both quantitative (surveys) and qualitative (interviews) methods aimed at exploring core aspects of the mentoring experience, as well as perceptions of care and satisfaction with RTP services among patients, staff and Peer Mentors. Workshop participants will receive information and materials that would enable them to consider setting up an RTP program in their own mental health settings.
Beyond Psychiatric Symptoms
Get PDFPsychic pain goes far beyond the set of psychiatric symptoms that afflict our patients. Actually, there is much debate in our field as to what gives rise to the other; is psychic pain a by-product of psychiatric symptoms, such as depression and anxiety, or are symptoms a manifestation of psychic pain, namely that we develop symptoms by virtue that the psychic pain is unbearable. Although many of our therapeutic interventions tend to target symptom removal, or at least their alleviation, fewer efforts are placed on understanding the patients’ psychic pain. During this workshop "Beyond Psychiatric Symptoms", the presenters will give a brief outline of what we know about psychic pain and the challenge that is faced in reaching it. With extensive use of audiovisually recorded clinical interviews, we will expand on these concepts. A special emphasis will be placed on the training of health professionals to be able to identify, tolerate, and work with such pain on a daily basis. As this workshop will present vignettes of actual clinical interviews with patients, any form of recording or taking pictures throughout the presentation is absolutely forbidden to preserve patients’ confidentiality.
How can we design a curriculum for a resilient medical student? - A blueprint for resiliency programs for med students in Japan
Get PDFRecent research around the world has consistently reported that medical students experience a high rate of psychological morbidity, depersonalization, and low personal accomplishment. Resilience-enhancing programs have been proposed and implemented even in Japan. However, most of them remain extracurricular programs that are not specifically tailored to medical students. Additionally, they mostly mimic resiliency programs in North America, although studies have indicated that cultural perspective to the self, others, and context contribute to the capacity to respond to a stressful situation.In this context, the presenters investigated what factors might affect the similarities or differences in the perceptions of resilience among experienced palliative care physicians in Canada and Japan in 2017-2018 in order to propose a theory for a resiliency curriculum from a different cultural perspective. This study showed that Japanese physicians are more likely to rely on “Relationships” with other persons such as mentors, family, friends, or colleagues; in contrast, Canadian physicians tended to be more focused on individual factors such as “Autonomy” and “Confidence”.As a result, Showa University School of Medicine in Japan has developed a progressively advancing resiliency program for first through fourth year medical students as part of a new curriculum, implementation of which will begin in the spring of 2020. This represents one of the largest revisions in the school’s history. In this presentation, a blueprint for resiliency programs in a new curriculum will be presented, including course description, course content, educational objectives, learning resources, timetables, and instructional strategies.
Shifting Organizational Cultures: Developing Leaders in Humanistic Interprofessional Education
Get PDFOrganizational cultures significantly influence faculty and clinician well-being, trainees’ professional identity formation, and the care of patients and families. The ability of interprofessional healthcare teams to work collaboratively is important for safe, high quality, relationship-centered care. A multi-site project, Faculty Development for the Interprofessional Teaching of Humanism,* was initiated to create a national curriculum in humanism and professionalism designed to train interprofessional education (IPE) faculty leaders. Boston Children’s Hospital / Harvard Medical School (BCH/HMS) is the first pediatric site selected to design and implement this curriculum. Our objectives were to: 1) develop a national curriculum in humanism and professionalism for IPE faculty leaders; 2) adapt the curriculum for pediatrics; and 3) create and sustain a faculty fellowship for IPE leaders at BCH/HMS that promotes humanistic values in organizational culture and learning and care environments. We designed and implemented the curriculum at nine national sites. Topics focus on collaboration, communication, and relationships and include: highly functioning teams; advanced team formation; patients’ perspectives; empathy; well-being, resilience, renewal; diversity & inclusion; appreciative inquiry; values; IPE and others. To achieve sustainability at BCH/HMS, we created a unique Faculty Fellowship for Leaders in Humanistic Interprofessional Education. To increase impact, we recruited co-sponsors from departments across BCH. Fellows participate in 1½-hour, twice-monthly small-group sessions for 8 months and design and implement a group project. Twenty-one faculty applied. The first cohort included 11 faculty representing medicine, social work, nursing, and psychology. The Faculty Fellowship provides opportunities for IPE faculty leaders to enhance teaching skills, collaboration, relationships, reflective capacities, and role modeling in humanism and professionalism, and to work together to foster humanistic values within organizational culture. *Supported by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as national PI; Dr. Rider as site PI)
Team Well-being and Resilience Practices in Hospice and Palliative Care
Get PDFHigh functioning, resilient teams do not happen by chance. Teams, similar to individuals, need to be educated, nurtured and formed over time, by a consistent vision and process. With proper team formation, the compassionate care of patients, families and colleagues can be developed, modeled and reinforced. Self-compassion is another focus to help caregivers cope with the stresses of the work and mitigate against burnout. The primary intervention which will be discussed is a regularly scheduled reflection process, e.g. 30 minutes weekly or 90 minutes monthly, with a pediatric hospice team, an inpatient palliative care team and an outpatient palliative care team. The reflection process incorporates mindful meditation, journaling, listening exercises, individual and group reflection to encourage and practice self-awareness, self-reflection, greater emotional intelligence and leadership skills. Specific tools employed include the Search Inside Yourself © Program, books by various authors, selected music, videos and personal journals. Qualitative feedback from team members, patient, family and colleague satisfaction scores has been positive. Buy-in from all team members, initially, was difficult, but over time, all team members have recognized the value of the process and have incorporated the exercises not only in their work, but in their personal lives and other roles/jobs. Other key success factors are organizational support for time for this process and individual champions to develop and lead the reflective process. The workshop will include a demonstration of exercises used in team reflections with learner participation.
Mindful Medical Practice Enabling the Management of Anorexia Nervosa, Alcohol Use Disorder and Separation Anxiety Disorder
Get PDFThis is a case report of comorbidity involving psychiatric disorders. The case could only be understood and managed effectively due to the combination of the therapeutic alliance as the cornerstone of mindful medical practice, psychotherapeutic approaches, and medication. A 27-year-old woman started a psychiatric treatment because of her alcohol problem. She drank daily until she passed out. After assessment, she was admitted into a detoxification facility for a month. As an outpatient, she remained abstinent for periods of time (1-9 months). She also struggled with binge eating, purging and disturbed perception of body image (perceiving herself as obese).The therapeutic alliance was the main component of treatment. She felt understood and not judged. She kept an open mind to understand her psychopathology. Psychoeducation was an important tool. It included sessions on addiction and the core symptoms of anorexia nervosa. Behavioural analysis and skills training helped to identify an anxiety disorder at the basis of all clinical presentation. The patient realized how ambivalent she was to change. After several episodes of alcohol use, binge eating and purging, she redefined her life goals. As a result, her motivation to change evolved. She became mindful of triggers and began to have fewer episodes of alcohol use. She could decrease her binge eating, purging behaviour, and became aware of her distorted perception of her body. She accepted to take medication to control her pathological anxiety, as well as started using paced breathing and muscle relaxation.