The International Journal of Whole Person Care
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Staying Present to Youth with an Unknown Future
No full textThe intention of this workshop is to provide an opportunity to explore the various dimensions of clinical practice known to support and enhance coping in adolescents living with a life-threatening illness. The objectives are to: 1) Present recent research findings related to the future thinking activities of adolescents in pediatric palliative care; 2) Acknowledge that these findings stretch us as clinicians to “sit with” and \"create time for\" the youth’s exploration of future in the context of an anticipated shortened life; 3) Discuss several cases and provide experiential activities that can prepare the clinician in ‘being with’ and ‘staying present’ to youth who are exploring their future that remains unknown by virtue of the trajectory of illness.The workshop will be broken down into three parts. In the first 30 minutes the findings from a doctoral study aimed at examining the future thinking of adolescents living with a progressive life-threatening neurodegenerative illness will be presented and discussed. Secondly, consideration will be given to how clinicians can mindfully prepare themselves for supporting adolescents and to consider aspects of the clinical self in our work with this population and finally, through both storytelling and the facilitation of active experiential activities, the presenters will share stories and ideas that have been integrated into existing practices
Impact d'une formation à la gestion du stress sur le vécu de la maladie dans l'insuffisance rénale chronique dans un hôpital universitaire français
No full textIntroduction : Les patients vivant avec une maladie rénale chronique expriment une franche altération de leur qualité de vie. Parmi les éléments impactant ces résultats, le stress chronique lié à la maladie et ses traitements et la douleur sont des plaintes très prévalentes et insuffisamment prises en charge. Cette étude évalue l'impact de la participation de patients insuffisants rénaux chroniques à un programme de gestion du stress par la méditation de pleine conscience (développé aux USA il y a plus de 25 ans par J. Kabat Zinn).Patients et Méthodes : L’enquête s’est concrétisée par la réalisation d’un dispositif « d’observation participante » par une sociologue au sein d’un programme MBSR (meditation-based-stress-reduction program) mis en place dans un service de néphrologie et la réalisation d’une enquête longitudinale : suivi des patients après la formation réalisés dans le cadre de « récits de vie ». Les résultats sont qualitatifs et portent sur la gestion du stress, la capacité à prendre soin de soi et à se mettre en posture de résilience.Résultats : Les premiers résultats permettent de rendre compte d’une amélioration des compétences des patients dans la gestion du stress, dans leur capacité à prendre soin d’eux, à anticiper les difficultés liées à leurs pathologies et à développer des mécanismes de compensation. L’enquête permet aussi de rendre compte d’une amélioration dans le vécu des malades du système de soin et une vision plus positive de l’hôpital et du rapport avec les soignants.Discussion et Conclusion : Les programmes d'education thérapeutique peuvent s'enrichir d'interventions pédagogiques orientées vers l'acquisition de compétences necessaires au maintien de soi en vie avec la maladie. L'amélioration de la gestion du stress par la méditation de pleine conscience pourrait être un moyen d'améliorer la qualité de vie des patients et en tous cas de diminuer le stress perçu
Compassion Training: The Missing Link in Healthcare Education?
No full textCompassion is an essential skill in whole person care. But, can it be cultivated through training?Current research in neuroscience elucidates the mechanisms of empathy and compassion and provides a new framework for professional education. It suggests that clinical detachment is neither effective for ensuring good care, nor a realistic strategy to prevent burnout. Cultivating compassion on the other hand, increases non-judgmental awareness, builds resilience, and enables us to respond more effectively to others’ needs with greater empathy (Frickson, 2008, Klimecki, 2102, Lutz, 2004). Moreover, it is a skill we can learn (Wasner et al, 2005, Lutz 2009). Despite these findings, however, training in compassion is largely absent in current professional curricula.Presenters will review current findings on compassion and its benefits, and demonstrate how we can train in it using examples from two unique compassion skills-training curricula: (1) a training for pediatric residents working in an inner-city hospital and (2) a certificate program in contemplative end-of-life care for hospice/palliative care workers. These models are inspired by the contemplative tradition of Tibetan Buddhism, with its long-standing and effective methodologies for deepening the human capacity for compassion. This approach has formed the basis of many scientific studies on compassion and the emerging field of contemplative-based, secular training models (Lutz, 2009). Participants engage in contemplations on compassion as well as mindfulness and meditation. The aim is to support clinicians to generate self-compassion - the foundation for building resilience and extending compassionate care – thereby improving communication and the overall quality of care.The workshop will introduce key principles, feature hands-on experience of selected methods, and include a discussion of the potential impact on the greater healthcare system.A wider implementation of compassion training promises to be the missing link for building a fulfilling clinical practice and strengthening our capacity to provide effective whole-person care
Self-Care and Self-Discipline through Qi Gong
No full textObjectives: One of the most important aspects of Qi Gong practice is to understand self-care and self-discipline as a practitioner’s service both to themself and to others. Self-care and self-discipline is physical, mental, and spiritual. By understanding one’s responsibility in this way, practitioners are free to practice medicine as a relationship between themselves and patients, helping them to become a healer.Methods: Traditional Chinese Medicine as a philosophy and practice will be introduced in the context of developing a successful Qi Gong practice. Basic Qi Gong techniques in posture, movement, breathing, phonation, and visualization will be demonstrated interactively. Increasing self-awareness will be emphasized, so that practitioners can use Qi Gong techniques to develop healing skills in their medical practice.Results: Although it requires long-term commitment to receive many of the deeper rewards of a dedicated Qi Gong practice, many of the early benefits are possible with only a modest investment in performing proper Qi Gong techniques. Practitioners will learn to increase their mindfulness and concentration, and understand the value of self-care and self-discipline. Through short practice sessions, the utility of Qi Gong in improving healing will become evident to the novice and initiated alike.Conclusions: Qi Gong is a series of ancient techniques from Traditional Chinese Medicine that promote self-care and self-discipline as a service to oneself and others. Qi Gong is a valuable method for taking care of oneself, and also allows practitioners to transfer its benefits to patients during the compassionate practice of medicine. It forms a foundation for whole person care by strengthening practitioners to provide healing to patients on the physical, mental, and spiritual levels
Challenging Conversations in Healthcare: Simulation-Based Interprofessional Learning
No full textIntroduction: Interprofessional education is central to the mission of the Institute for Professionalism and Ethical Practice, based at Boston Children's Hospital and affiliated with Harvard Medical School. The Institute’s Program to Enhance Relational and Communication Skills (PERCS) offers simulation-based interprofessional workshops designed to help trainees and practitioners engage in challenging healthcare conversations across situations such as critical care, primary care, parent presence during resuscitation, spiritual distress, adverse medical outcomes, informed consent, organ donation, and others.Objective: To describe the pedagogy, recruitment statistics and sustained participant outcomes of the Program to Enhance Relational and Communication Skills (PERCS).Methods: The pedagogical framework is based on creating safety for learning, emphasizing moral and relational aspects of care, suspending hierarchy to support interprofessional learning, honoring multiple perspectives, and valuing reflection and self-discovery. Programs bring together physicians, nurses, social workers, psychologists, chaplains and other healthcare professionals for a wide range of innovative educational offerings. Core learning occurs through live enactments of challenging conversations with professional actors portraying patients and family members, followed by guided debriefings that support individual and group reflection.Results: Approximately 3000 local, national and international professionals have participated since the program’s inception in 2002. PERCS workshop participants have reported a greater sense of preparation, confidence, improved communication and relational skills, and decreased anxiety when holding challenging healthcare conversations immediately following training and up to 12 months later. Benefits of the training were not related to discipline, level of experience or previous educational opportunities.Conclusions: Participants reported enhanced communication and relational skills. The program strives to develop relational competence in the healthcare world, including qualities of compassion, trust, and respect between clinicians and patients, and increased attention to interprofessional collaboration and knowledge sharing
The Health and Wellness of Future Physicians: Barriers to Change and Innovations in Undergraduate Medical Curricula
No full textObjectives: 1) To build on existing theory about the health and wellbeing of medical students and physicians; 2) To explore barriers to educational and institutional change; 3) To identify current educational innovations that improve the resilience of students and future doctors.Methods: Current explanatory models and research findings have been augmented through interviews with key academics and educators in North America, Australia and UK, as well as through reviewing innovative curricular interventions related to health and wellness of students and physicians.Results: Medical students are at risk of anxiety, depression and burnout,(1) while doctors suffer a range of occupational health hazards that illustrate psychological vulnerability.(2) Many commentators have called for changes to undergraduate education to improve the general resilience of doctors.(3, 4) The long delay in addressing physician stress may relate to the tacit assumptions of biomedicine that act as guiding principles in clinical practice.(5) While helpful in increasing the efficacy of modern medicine, these assumptions act as barriers to more progressive curricula. A ‘whole person care’ paradigm of patients is becoming well theorised, but acknowledging the ‘whole person’ of the student and physician is still work-in-progress. Fortunately, recent initiatives in many countries illustrate substantial progress. Undergraduate programs now focus on self-awareness, interpersonal skills, work-life balance, whole person care, and career choice. Methods vary widely and include coaching on physical, mental, and emotional health. Mindfulness, mentoring and Balint groups are increasing. Reflective practice is a prominent feature in a revised approach to professionalism.Conclusions: There is increasing evidence that the self-care of physicians will impact on patient outcomes. (6, 7) We also have a moral responsibility as educators, faculty and senior clinicians to provide more humane learning and working environments for students and doctors. Innovative educational initiatives are finding ways to overcome significant historical and institutional barriers.References1. Jennings M. Medical student burnout: interdisciplinary exploration and analysis. J Med Humanities. 2009;30(4):253-69. 2. Linzer M, Gerrity M, Douglas JA, McMurray JE, Williams ES, Konrad TR. Physician stress: results from the physician worklife study. Stress Health. 2002;18(1):37-42. 3. Dunn L, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44-53.4. Seritan A, Hunt J, Shy A, Rea M, Worley L. The state of medical student wellness: A call for culture change. Acad Psychiatry. 2012;36(1):7-10.5. McWhinney I. Changing models: The impact of Kuhn's theory on medicine. Fam Pract. 1984;1(1):3 -9.6. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294-300. 7. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. The Lancet. 2009;374(9702):1714-21
Perceived Effects of a Somatic Psychopedagogy (SPP) Program in Nurse Training: An Exploratory Study
No full textBackground: Developed in Europe in the 1980’s, somatic psychopedagogy (SPP) is a formative practice geared toward care giving and support. Characterized as a type of mind-body medicine, it examines how the use of the body and its movement allows for the development of one’s conscience, one’s sense of self and of others, which are all desirable qualities for professionals within the health care sector.Purpose: To explore if and how SPP training followed by nurses modifies their perception of the quality of their self awareness, their presence in regard to others, as well as their relationship with respect to health and their professional practice.Methods: Qualitative research based on two types of semi-structured interviews: comprehensive and elicitation. Exploratory interviews with three nurses trained (or in training) in SPP. The content of the interviews was first analyzed thematically then grouped by categories.Findings: The three participants perceived a change in the quality of their presence with respect to themselves and to others as well as changes within the nature of their relationships with their patients, colleagues and healthcare team members. Content analysis of the interviews has allowed us to conclude that relationships with the health care team evolved into a better ability to give recognition and a better quality of interaction between members. Participants also reported an increased ability to express their opinions in both their personal and professional lives. A second level of analysis has allowed for the identification of differences between nurses just finishing their first year of training and those having completed the full four-year course.Conclusion: Interesting transformations are reported at different levels confirming the relevance of a second phase of the project. The latter will permit to identify whether physicians trained in SPP experience changes similar to those of the nurses, and if so, whether they perceive these as having an impact on their practice
Facilitating Whole Person Care Using Video Reflexive Ethnography
No full textAim: Explore the application and potential of video reflexive ethnography (VRE) to facilitate whole person care (WPC).Objectives: Discuss the ethical issues associated with VRE; explore the foundations of the methodology; and discuss its potential to facilitate WPC.Description: WPC requires a paradigm shift in how we see those we care for, how we see our co-workers and how we see ourselves. VRE involves videoing real-time everyday clinical practice and or patient and family accounts of care, and then involving participants to analyse the visual data that they feature in or have gathered themselves. Uniquely, video footage can challenge the taken for granted and attune people to dimensions of themselves and others that they might not otherwise have considered. This has the potential to open people up to alternative ways of thinking and perceiving, being and acting. It offers “transformative potential” towards WPC.We draw from our diverse disciplinary perspectives to explore the potential of VRE as a tool to facilitate WPC. Using specific examples from five research studies, this workshop will demonstrate the use of VRE in a variety of health care contexts. The contexts of the studies we draw from include: end of life care; autism diagnostics; infection control, and intensive care.The workshop proceeds in four parts. We first invite you, the participant, to engage in a video reflexive event, where you are expected to reflect on the socio-interactive conduct that you produce as a group in response to a specific task. We then describe the process of VRE, outline its pedagogic and theoretical foundations, and present some examples from our research. We then invite questions about the theoretical basis and practical approach of VRE. Finally, participants will be asked to project a version of reflexive video onto their 'home' area of research, and reason about potential outcomes.1. Carroll, K., Iedema, R. and Kerridge, I. 2008, 'Reshaping ICU Ward Round Practices Using Video Reflexive Ethnography', Qualitative Health Research, vol. 18, no. 3, pp. 380-390.2. Collier, A. 2012, 'Safe Healing Environments', in N. Godbold and M. Vaccarella (eds), Autonomous Responsible Alone: The Complexities of Patient Empowerment, Interdisciplinary Press, London, pp. 155-170.3. Iedema, R. 2011, 'Creating Safety by Strengthening Clinicians' Capacity for Reflexivity ', British Medical Journal, vol. 20, pp. S83-S86.4. Iedema, R. and Carroll, K. 2011, 'The 'clinalyst': Institutionalising reflexive space to realise safety and flexible systematisation in health care', Journal of Organisational Change Management vol. 4, no. 1, pp. 65-86.5. Iedema, R., Long, D., Forsyth, D. and Lee, B.B. 2006, 'Visibilising Clinical Work: Video ethnography in the contemporary hospital', Health Sociology Review, vol. 15, pp. 156-168
Sharing and Supporting the Hopes and Dreams of Students and Faculty in a Canadian BScN Program
No full textHealthcare educators are in a unique position to support students’ personal and professional development. The UOIT-DC Nursing Program curriculum is founded on caring values that assert a commitment to the primacy of relationships. According to humanistic nursing, caring involves the interrelated concepts of ‘being’ and ‘doing’ in which both require an active presence and willingness to come to know another person (Paterson and Zderad, 1976). A deeply held tenet of nursing practice is the notion that when a nurse knows or understands a person, he or she will be better able to care for that person. We believe that this notion also pertains to student and faculty relationships in nursing education, ultimately leading to more effective and meaningful learning opportunities and experiences.This poster will report on a qualitative study exploring undergraduate nursing students’ hopes and dreams when they begin their education and the ways these hopes and dreams may shift and evolve as they progress through the program. The intersections of students’ hopes and dreams for their education and faculty members’ hopes and dreams in teaching students will be presented. The impetus for the project arose from conversations among faculty members about the complex relational nature of nursing education and our hope to enhance relational awareness and practices through a deeper understanding of the aspirations and goals that students hold. Exploration of how the findings may contribute to deeper understandings of and responsiveness to students and the significance of nursing practice and education to them will be presented.ReferencesPaterson, J. G., and Zderad, L. T. (1976). Humanistic nursing. New York: John Wiley and Sons
Faut-il parler de l'âme? Réflexions à propos de 2 patients.
No full textDeux patients souffrant d’un cancer broncho-pulmonaire métastatique ont évoqué l’âme.Patient 1 : il ne signale aucune inquiétude face à la mort « je suis au clair avec ma spiritualité ». Il croit en une vie après la mort, avec lumière et amour, dans la paix de Dieu. De retour à domicile, il écrit par mail avant son décès : « je crois avoir trouvé une approche pour parler de la spiritualité. Référez-vous aux temps anciens et aux médecines orientales ou africaines, quand les médecins étaient aussi des médecins de l’âme »Patient 2 : une forte angoisse a cessé brutalement « Docteur, j’ai découvert que j’avais une âme et qu’elle est belle ». Cette découverte est liée à la discussion avec un chaman, accompagnant sa famille. Ce patient a évoqué un grandissement de son âme, et son immortalité.Des étudiants hospitaliers (EH, 26/31) ont participé à une étude par questionnaire sur la perception face à la fin de vie. Pour 21 EH (81%) l’âme existe. Leurs définitions parlent de souffle, présence, croyance, entité abstraite, invisible, ce qui donne la vie, ce qui reste après la mort, Divine ou moléculaire. Parmi eux, 10 pensent que l’âme est immortelle, 2 non, 7 doutent et 2 ne savent pas. La croyance la plus fréquente est l’existence de l’âme (81%), suivie de l’existence de Dieu/Puissance supérieure (62%), puis d’une forme de vie après la mort (54%).Conclusion : Un patient évoque l’âme et son immortalité. L’autre souhaite un médecin de l’âme. Même si notre civilisation ne parle plus de l’âme, l’existence de l’âme est une croyance forte chez les étudiants hospitaliers. Face à une souffrance spirituelle, faut-il aborder la question de l’âme et en parler? En médecine globale, faut-il redonner, à côté du corps, une place à l’âme